Healthcare Provider Details

I. General information

NPI: 1962585471
Provider Name (Legal Business Name): MELISSA ANN WILLIS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8264 W STATE ROUTE 41
COVINGTON OH
45318-1248
US

IV. Provider business mailing address

2455 PIQUA TROY RD
TROY OH
45373-9772
US

V. Phone/Fax

Practice location:
  • Phone: 937-473-3333
  • Fax: 937-473-3000
Mailing address:
  • Phone: 937-473-3333
  • Fax: 937-473-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-21148
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: