Provider Demographics
NPI:1114502846
Name:ILIE-MELAS, JONATHAN CONSTANTIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CONSTANTIN
Last Name:ILIE-MELAS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2354 WHITE OAK CT APT 2
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1541
Mailing Address - Country:US
Mailing Address - Phone:718-637-7975
Mailing Address - Fax:
Practice Address - Street 1:2354 WHITE OAK CT APT 2
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1541
Practice Address - Country:US
Practice Address - Phone:718-637-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist