Provider Demographics
NPI:1427577386
Name:KELLEY, MELISA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISA
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MELISA
Other - Middle Name:
Other - Last Name:TONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:507 CONEJO CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-6203
Mailing Address - Country:US
Mailing Address - Phone:510-386-0703
Mailing Address - Fax:
Practice Address - Street 1:5860 W LAS POSITAS BLVD STE 19
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8557
Practice Address - Country:US
Practice Address - Phone:925-317-7960
Practice Address - Fax:833-543-0292
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist