Healthcare Provider Details

I. General information

NPI: 1063802940
Provider Name (Legal Business Name): MELISSA POLLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 SELING AVE
BALTIMORE MD
21237
US

IV. Provider business mailing address

1521 SELING AVE
BALTIMORE MD
21237-1660
US

V. Phone/Fax

Practice location:
  • Phone: 443-617-0625
  • Fax:
Mailing address:
  • Phone: 443-617-0625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT13862
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: