MEDICARE: MELISSA DIANE MELLINGER CPHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	260100103071220

General Provider Information

NPI Number	:	1033288519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA DIANE MELLINGER CPHT

Provider Business Mailing Address
First Line	:	PO BOX 387
Second Line	:
City	:	OAKLAND
State	:	MD
Zip	:	21550-0387
Country	:	US
Telephone Number	:	301-334-3913
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 S 2ND ST
Second Line	:
City	:	OAKLAND
State	:	MD
Zip	:	21550-1520
Country	:	US
Telephone Number	:	301-334-3913
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/08/2007

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