MEDICARE: DR. MELISSA SHERONA THOMPSON PHARM.D

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	1835P1200X	Pharmacotherapy Pharmacist	28R103223400	NJ

General Provider Information

NPI Number	:	1619123791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA SHERONA THOMPSON PHARM.D

Provider Business Mailing Address
First Line	:	5437 8TH ST
Second Line	:
City	:	FORT DIX
State	:	NJ
Zip	:	08640-5006
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5437 8TH ST
Second Line	:
City	:	FORT DIX
State	:	NJ
Zip	:	08640-5006
Country	:	US
Telephone Number	:	609-562-2999
Fax Number	:

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

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	04/10/2013

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