Provider Demographics
NPI:1477141984
Name:CHULLUM, MELISA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:
Last Name:CHULLUM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MELISA
Other - Middle Name:
Other - Last Name:CHULLUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:343 W MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2730
Mailing Address - Country:US
Mailing Address - Phone:860-328-6276
Mailing Address - Fax:
Practice Address - Street 1:343 W MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2730
Practice Address - Country:US
Practice Address - Phone:973-992-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI034858001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist