Provider Demographics
NPI:1326333923
Name:DEANSERIS, MELISSA MARY
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:MARY
Last Name:DEANSERIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6184
Mailing Address - Country:US
Mailing Address - Phone:401-724-6800
Mailing Address - Fax:401-723-2160
Practice Address - Street 1:727 EAST AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6184
Practice Address - Country:US
Practice Address - Phone:401-724-6800
Practice Address - Fax:401-723-2160
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist