Provider Demographics
NPI:1144739186
Name:BASTACKY, MELISSA LAUREN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LAUREN
Last Name:BASTACKY
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 1:421 ARDEN DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4856
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3459 FIFTH AVENUE
Practice Address - Street 2:NE626 MUH
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15146-3236
Practice Address - Country:US
Practice Address - Phone:412-692-2835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist