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NPI Code Detail

MEDICARE: MARY SUSIE MELVIN

MEDICARE: MARY SUSIE MELVIN
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
1183700000XPharmacy Technician0230000646VA

General Provider Information

NPI Number : 1619964319
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY SUSIE MELVIN
Provider Business Mailing Address
First Line : 3111 RIDGE RD
Second Line :
City : CHINCOTEAGUE ISLAND
State : VA
Zip : 23336-1325
Country : US
Telephone Number : 757-336-6063
Fax Number :
Provider Business Practice Location Address
First Line : 6300 MADDOX BLVD
Second Line :
City : CHINCOTEAGUE ISLAND
State : VA
Zip : 23336-2617
Country : US
Telephone Number : 757-336-3115
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 07/08/2007

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Directions to “ MARY SUSIE MELVIN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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