Provider Demographics
NPI:1326649393
Name:HEDRICK, MELISSA SUE (RPH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4418 MCCANDLISS RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-8507
Mailing Address - Country:US
Mailing Address - Phone:937-371-0898
Mailing Address - Fax:
Practice Address - Street 1:70 HOSPITALITY DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-2779
Practice Address - Country:US
Practice Address - Phone:937-376-3700
Practice Address - Fax:937-376-3989
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist