Healthcare Provider Details

I. General information

NPI: 1952010761
Provider Name (Legal Business Name): MELANIE TESS MAHONEY PHARMD, CPP, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 DUKE MEDICINE CIR # 2F2G
DURHAM NC
27710-4000
US

IV. Provider business mailing address

4340 FLINTLOCK LN
DURHAM NC
27704-2378
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-6155
  • Fax:
Mailing address:
  • Phone: 612-281-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number70411
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31511
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: