Provider Demographics
NPI:1003090226
Name:REESE, MELISSA LOUISE (RP040901L)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LOUISE
Last Name:REESE
Suffix:
Gender:F
Credentials:RP040901L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 RED OAK RD
Mailing Address - Street 2:
Mailing Address - City:FLINTON
Mailing Address - State:PA
Mailing Address - Zip Code:16640
Mailing Address - Country:US
Mailing Address - Phone:814-687-4092
Mailing Address - Fax:
Practice Address - Street 1:1564 MAIN ST
Practice Address - Street 2:
Practice Address - City:COALPORT
Practice Address - State:PA
Practice Address - Zip Code:16627
Practice Address - Country:US
Practice Address - Phone:814-672-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040901L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist