Healthcare Provider Details

I. General information

NPI: 1053318220
Provider Name (Legal Business Name): SARAH TOLLISON MELTON PHARMD, BCPP, CGP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2005
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 7 VETERAN ADMINISTRATION CAMPUS
JOHNSON CITY TN
37614-1701
US

IV. Provider business mailing address

23104 VIRGINIA TRL
BRISTOL VA
24202-4955
US

V. Phone/Fax

Practice location:
  • Phone: 423-439-6571
  • Fax: 276-415-9776
Mailing address:
  • Phone: 276-971-6097
  • Fax: 276-971-6097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number0202010464
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: