Healthcare Provider Details

I. General information

NPI: 1225166549
Provider Name (Legal Business Name): MELANIE MAIN PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 NORTH MAIN STREET
UTICA OH
43080
US

IV. Provider business mailing address

235 VILLAGE DR
JOHNSTOWN OH
43031-9197
US

V. Phone/Fax

Practice location:
  • Phone: 740-892-2971
  • Fax: 740-892-3075
Mailing address:
  • Phone: 740-967-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24246-03
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: