Provider Demographics
NPI:1346833373
Name:BROOME, MELISSA HALL (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:HALL
Last Name:BROOME
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 1:120 SANDY FORD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3444
Mailing Address - Country:US
Mailing Address - Phone:423-834-2202
Mailing Address - Fax:
Practice Address - Street 1:1970 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2924
Practice Address - Country:US
Practice Address - Phone:251-666-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9756183500000X
AL21700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist