Healthcare Provider Details

I. General information

NPI: 1821579657
Provider Name (Legal Business Name): ALYSSA MELODY GOSNELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 JANE ST
PITTSBURGH PA
15203-2361
US

IV. Provider business mailing address

2300 JANE ST
PITTSBURGH PA
15203-2361
US

V. Phone/Fax

Practice location:
  • Phone: 412-431-6773
  • Fax:
Mailing address:
  • Phone: 412-431-6773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452538
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: