Healthcare Provider Details

I. General information

NPI: 1811298128
Provider Name (Legal Business Name): MELISSA DICKERSON MACCIA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA BETH DICKERSON

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 N CHURCH ST STE 300
GREENSBORO NC
27401-1037
US

IV. Provider business mailing address

1126 N CHURCH ST STE 300
GREENSBORO NC
27401-1037
US

V. Phone/Fax

Practice location:
  • Phone: 336-938-0717
  • Fax: 336-938-0757
Mailing address:
  • Phone: 336-938-0717
  • Fax: 336-938-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17540
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: