Healthcare Provider Details

I. General information

NPI: 1144535329
Provider Name (Legal Business Name): MELISSA MORAN PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 WATERVILLE SWANTON RD
WATERVILLE OH
43566-9726
US

IV. Provider business mailing address

2434 W LASKEY RD
TOLEDO OH
43613-3504
US

V. Phone/Fax

Practice location:
  • Phone: 419-878-1040
  • Fax: 419-878-1042
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03221021
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: