Healthcare Provider Details

I. General information

NPI: 1235250853
Provider Name (Legal Business Name): MELISSA STANCANELLI PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MIDDLEVILLE RD
NORTHPORT NY
11768-2200
US

IV. Provider business mailing address

79 MIDDLEVILLE RD
NORTHPORT NY
11768-2200
US

V. Phone/Fax

Practice location:
  • Phone: 631-266-6068
  • Fax:
Mailing address:
  • Phone: 631-266-6068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051265
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051265
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: