Healthcare Provider Details

I. General information

NPI: 1538152822
Provider Name (Legal Business Name): KATHLEEN MARY MELBOURNE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RESERVOIR AVE SUITE 1D COASTAL MEDICAL
PROVIDENCE RI
02907-3565
US

IV. Provider business mailing address

50 MORRIS ST
WARWICK RI
02889-3426
US

V. Phone/Fax

Practice location:
  • Phone: 401-781-2400
  • Fax: 401-781-2687
Mailing address:
  • Phone: 401-739-0176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH03595
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH03595
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: