Provider Demographics
NPI:1417544669
Name:MELLEN, TERRELL ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TERRELL
Middle Name:ELIZABETH
Last Name:MELLEN
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 1:943 PRESTON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4421
Mailing Address - Country:US
Mailing Address - Phone:434-995-5595
Mailing Address - Fax:434-995-5621
Practice Address - Street 1:943 PRESTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4421
Practice Address - Country:US
Practice Address - Phone:434-995-5595
Practice Address - Fax:434-995-5621
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA202217253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist