Provider Demographics
NPI:1326642794
Name:MELCHERT, PHILIP WALKER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:WALKER
Last Name:MELCHERT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 SW ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2409
Mailing Address - Country:US
Mailing Address - Phone:352-373-2507
Mailing Address - Fax:
Practice Address - Street 1:3404 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-2409
Practice Address - Country:US
Practice Address - Phone:352-373-2507
Practice Address - Fax:352-377-9452
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist