Provider Demographics
NPI:1073845699
Name:MARTIN, MELANIE E (RPH)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5202 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13408-1425
Mailing Address - Country:US
Mailing Address - Phone:315-824-2200
Mailing Address - Fax:
Practice Address - Street 1:103 UTICA ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1100
Practice Address - Country:US
Practice Address - Phone:315-824-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-07
Last Update Date:2010-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0437421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist