Healthcare Provider Details

I. General information

NPI: 1740313212
Provider Name (Legal Business Name): MELESSA AUTREY LIEBZEIT PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5153 SUNSET LAKE RD
APEX NC
27539-8792
US

IV. Provider business mailing address

101 BANYAN CREEK PL
APEX NC
27539-8500
US

V. Phone/Fax

Practice location:
  • Phone: 919-290-2630
  • Fax:
Mailing address:
  • Phone: 252-458-1130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16781
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: