Healthcare Provider Details

I. General information

NPI: 1063302941
Provider Name (Legal Business Name): MELISSA A GANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19471 LAKE DR
TRIMBLE OH
45782-2508
US

IV. Provider business mailing address

9790 FEATHERSTONE RD
STEWART OH
45778-9611
US

V. Phone/Fax

Practice location:
  • Phone: 740-767-3851
  • Fax:
Mailing address:
  • Phone: 704-241-3299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03321909
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: