Healthcare Provider Details

I. General information

NPI: 1982985206
Provider Name (Legal Business Name): MELISSA PRYBOR PHARMD,BSPS,MBA,RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CABELAS BLVD E WALGREENS #12288
DUNDEE MI
48131-9693
US

IV. Provider business mailing address

2132 STIRRUP LN APT A102
TOLEDO OH
43613-5610
US

V. Phone/Fax

Practice location:
  • Phone: 734-529-5395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03230611
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302040372
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: