Provider Demographics
NPI:1508056565
Name:MURRAY, MELISSA ANN (PHARM D)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MR
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:325 THISTLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2950
Mailing Address - Country:US
Mailing Address - Phone:304-677-1883
Mailing Address - Fax:708-202-3582
Practice Address - Street 1:5000 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-3030
Practice Address - Country:US
Practice Address - Phone:708-202-4500
Practice Address - Fax:708-202-3582
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007035183500000X, 1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV00Medicaid