Provider Demographics
NPI:1477272839
Name:HAAG, MELODY MARIE
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:MARIE
Last Name:HAAG
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 1:20560 CHARLOTTE BLVD S
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-7578
Mailing Address - Country:US
Mailing Address - Phone:908-625-5277
Mailing Address - Fax:
Practice Address - Street 1:18993 MUNCHY BRANCH RD
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-8762
Practice Address - Country:US
Practice Address - Phone:302-226-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0015838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist