Provider Demographics
NPI:1164754784
Name:MELVIN, TENEISHA NISREEN (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:TENEISHA
Middle Name:NISREEN
Last Name:MELVIN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 SPRINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-2918
Mailing Address - Country:US
Mailing Address - Phone:973-573-8819
Mailing Address - Fax:
Practice Address - Street 1:526 W 30TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1310
Practice Address - Country:US
Practice Address - Phone:646-968-4689
Practice Address - Fax:645-968-4690
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-07
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist