MEDICARE: MELISSA CALLIS

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	183500000X	Pharmacist	14839	AL

General Provider Information

NPI Number	:	1285305615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA CALLIS

Provider Business Mailing Address
First Line	:	7192 N LAKE DR
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-9046
Country	:	US
Telephone Number	:	334-467-9151
Fax Number	:

Provider Business Practice Location Address
First Line	:	7192 N LAKE DR
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-9046
Country	:	US
Telephone Number	:	334-467-9151
Fax Number	:

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

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	09/24/2021

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Directions to “ MELISSA CALLIS ” Practice Location

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