Healthcare Provider Details

I. General information

NPI: 1255617932
Provider Name (Legal Business Name): MELANIE MABINS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 ELM TREE LN UK HEALTHCARE POLK-DALTON CLINIC
LEXINGTON KY
40507-2117
US

IV. Provider business mailing address

789 S LIMESTONE ST COLLEGE OF PHARMACY, BPC 275
LEXINGTON KY
40536-0596
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-2802
  • Fax:
Mailing address:
  • Phone: 859-323-2986
  • Fax: 859-323-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number012684
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: