Provider Demographics
NPI:1093166761
Name:GREGG, MELANIE MICHELE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:MICHELE
Last Name:GREGG
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 1:120 ADAM RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1806
Mailing Address - Country:US
Mailing Address - Phone:404-290-1501
Mailing Address - Fax:
Practice Address - Street 1:120 ADAM RIDGE LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1806
Practice Address - Country:US
Practice Address - Phone:404-290-1501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0181491835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care