Provider Demographics
NPI:1518248061
Name:LUDINGTON, MELISSA (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:LUDINGTON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2607
Mailing Address - Country:US
Mailing Address - Phone:904-259-2800
Mailing Address - Fax:904-259-2864
Practice Address - Street 1:657 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2607
Practice Address - Country:US
Practice Address - Phone:904-259-2800
Practice Address - Fax:904-259-2864
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032189300Medicaid