Provider Demographics
NPI:1164772596
Name:BUSH, MELISSA IRENE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:IRENE
Last Name:BUSH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:IRENE
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:805 ENTERPRISE RD
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-7821
Mailing Address - Country:US
Mailing Address - Phone:843-841-2228
Mailing Address - Fax:843-841-0294
Practice Address - Street 1:805 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-7821
Practice Address - Country:US
Practice Address - Phone:843-841-2228
Practice Address - Fax:843-841-0294
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist