Provider Demographics
NPI:1164821005
Name:MULLIS, MELISSA MICHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MICHELLE
Last Name:MULLIS
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 1:1500 REGENCY PKWY
Mailing Address - Street 2:#106
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-8529
Mailing Address - Country:US
Mailing Address - Phone:706-461-3317
Mailing Address - Fax:
Practice Address - Street 1:101 W WOODCROFT PKWY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9471
Practice Address - Country:US
Practice Address - Phone:919-484-8817
Practice Address - Fax:919-572-1938
Is Sole Proprietor?:No
Enumeration Date:2014-08-16
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist