Healthcare Provider Details

I. General information

NPI: 1740566652
Provider Name (Legal Business Name): MELANIE GARDNER SAIN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 CHARLOIS BLVD
WINSTON SALEM NC
27103-1507
US

IV. Provider business mailing address

255 CHARLOIS BLVD
WINSTON SALEM NC
27103-1507
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-1044
  • Fax: 336-718-1448
Mailing address:
  • Phone: 336-718-1044
  • Fax: 336-718-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13478
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: