Provider Demographics
NPI:1063646016
Name:NULTON, MELISSA ANNE JONES (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE JONES
Last Name:NULTON
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 1:8975 HOME GUARD DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2190
Mailing Address - Country:US
Mailing Address - Phone:703-425-2030
Mailing Address - Fax:
Practice Address - Street 1:8975 HOME GUARD DR
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2190
Practice Address - Country:US
Practice Address - Phone:703-425-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10725183500000X
AK18031835P0018X
VA02022119211835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist