Provider Demographics
NPI:1073811964
Name:BROWN, MELISSA (PHARM D)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MAMULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-2462
Mailing Address - Country:US
Mailing Address - Phone:864-878-0599
Mailing Address - Fax:864-878-0756
Practice Address - Street 1:101 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2462
Practice Address - Country:US
Practice Address - Phone:864-878-0599
Practice Address - Fax:864-878-0756
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist