Provider Demographics
NPI:1154666089
Name:MELNICK, LINDA SUSAN (RPH)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUSAN
Last Name:MELNICK
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 1:7970 BAYBERRY RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7480
Mailing Address - Country:US
Mailing Address - Phone:904-733-6099
Mailing Address - Fax:800-888-4121
Practice Address - Street 1:7970 BAYBERRY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7480
Practice Address - Country:US
Practice Address - Phone:904-733-6099
Practice Address - Fax:800-888-4121
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 18602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist