Provider Demographics
NPI:1215221031
Name:MIRISCIOTTI, MELANIE L (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:MELANIE
Middle Name:L
Last Name:MIRISCIOTTI
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 1:33860 S GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-6115
Mailing Address - Country:US
Mailing Address - Phone:586-913-0294
Mailing Address - Fax:
Practice Address - Street 1:33860 S GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-6115
Practice Address - Country:US
Practice Address - Phone:586-913-0294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist