Provider Demographics
NPI:1407193576
Name:BOND, MELISSA DAWN
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:DAWN
Last Name:BOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 LEBANON PIKE
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1314
Mailing Address - Country:US
Mailing Address - Phone:615-874-0898
Mailing Address - Fax:615-874-9857
Practice Address - Street 1:4670 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1314
Practice Address - Country:US
Practice Address - Phone:615-874-0898
Practice Address - Fax:615-874-9857
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist