Provider Demographics
NPI:1497356422
Name:ELELE, MELODY NNENNA
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:NNENNA
Last Name:ELELE
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 1:40982 PIPITS LN
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2246
Mailing Address - Country:US
Mailing Address - Phone:240-925-0705
Mailing Address - Fax:
Practice Address - Street 1:11740 ROUSBY HALL RD
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-2606
Practice Address - Country:US
Practice Address - Phone:410-394-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist