Provider Demographics
NPI:1407471022
Name:DIAMOND, MELISSA MAUREEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MAUREEN
Last Name:DIAMOND
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 1:3478 ROLLING ACRES RD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-9307
Mailing Address - Country:US
Mailing Address - Phone:850-384-5162
Mailing Address - Fax:
Practice Address - Street 1:3478 ROLLING ACRES RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-9307
Practice Address - Country:US
Practice Address - Phone:850-384-5162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16603183500000X
FL46663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist