Provider Demographics
NPI:1033497763
Name:KOLASA, MELANIE SUZANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:SUZANNE
Last Name:KOLASA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S LASALLE STREET
Mailing Address - Street 2:C/O RITE AID PHARMACY
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-0000
Mailing Address - Country:US
Mailing Address - Phone:919-383-5591
Mailing Address - Fax:
Practice Address - Street 1:200 S LASALLE STREET
Practice Address - Street 2:C/O RITE AID PHARMACY
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-0000
Practice Address - Country:US
Practice Address - Phone:919-383-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist