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General NPI Number Information
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NPI Number | 1689274037
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Entity Type | Individual
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Provider Name | VANESSA LYNN MELLOTT PHARM. D.
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Gender | Female
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 1936 N LECANTO HWY
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City | LECANTO
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State | FL
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Zip | 34461-9680
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Country | US
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Telephone | 352-228-6003
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Fax | 352-228-6004
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Provider Business Mailing Address
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Address Line | 6285 E WAVERLY ST
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City | INVERNESS
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State | FL
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Zip | 34452-8121
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Country | US
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Telephone | 352-257-2353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS49486
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License Number State | FL
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