Provider Demographics
NPI:1316217821
Name:PEREZ, MELISSA LYNN (PHARM D)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5631
Mailing Address - Country:US
Mailing Address - Phone:813-901-8558
Mailing Address - Fax:813-901-8567
Practice Address - Street 1:4141 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5631
Practice Address - Country:US
Practice Address - Phone:813-901-8558
Practice Address - Fax:813-901-8567
Is Sole Proprietor?:No
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist