Provider Demographics
NPI:1376153817
Name:MELTO, MARY JANE (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:MELTO
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 1:533 INDIANA DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2107
Mailing Address - Country:US
Mailing Address - Phone:814-384-3116
Mailing Address - Fax:814-286-6847
Practice Address - Street 1:533 INDIANA DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-2107
Practice Address - Country:US
Practice Address - Phone:814-384-3116
Practice Address - Fax:814-286-6847
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043332L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist