Healthcare Provider Details

I. General information

NPI: 1073342697
Provider Name (Legal Business Name): MELANIE MACKAY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 MAPLE ST
DANVERS MA
01923-4065
US

IV. Provider business mailing address

9 AVON CT
WAKEFIELD MA
01880-2201
US

V. Phone/Fax

Practice location:
  • Phone: 978-304-8458
  • Fax:
Mailing address:
  • Phone: 617-610-8758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26370
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: