Provider Demographics
NPI:1396004925
Name:DIZON, MELISSA I (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:I
Last Name:DIZON
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1208
Mailing Address - Country:US
Mailing Address - Phone:201-936-0220
Mailing Address - Fax:
Practice Address - Street 1:34 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1208
Practice Address - Country:US
Practice Address - Phone:201-936-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI294731835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric