=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003410721
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA MEARS PHARMD, RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2020
-----------------------------------------------------
Last Update Date | 11/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 HAMPTON DR
-----------------------------------------------------
City | LONDONDERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03053-3424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-421-0076
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 57 WASHINGTON ST APT 2E
-----------------------------------------------------
City | HAVERHILL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01832-5705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-838-1581
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PHCY-01056
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------