=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053566331
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA M REOME RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2008
-----------------------------------------------------
Last Update Date | 11/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3112 VESTAL PKWY E
-----------------------------------------------------
City | VESTAL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13850-2038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-729-6204
-----------------------------------------------------
Fax | 607-729-6204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3112 VESTAL PKWY E
-----------------------------------------------------
City | VESTAL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13850-2038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-729-6204
-----------------------------------------------------
Fax | 607-729-6204
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 048928
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------