Provider Demographics
NPI:1063302941
Name:GANT, MELISSA A
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:GANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9790 FEATHERSTONE RD
Mailing Address - Street 2:
Mailing Address - City:STEWART
Mailing Address - State:OH
Mailing Address - Zip Code:45778-9611
Mailing Address - Country:US
Mailing Address - Phone:704-241-3299
Mailing Address - Fax:
Practice Address - Street 1:19471 LAKE DR
Practice Address - Street 2:
Practice Address - City:TRIMBLE
Practice Address - State:OH
Practice Address - Zip Code:45782-2508
Practice Address - Country:US
Practice Address - Phone:740-767-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03321909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist