Provider Demographics
NPI:1518250935
Name:SUMMERELL, MELANIE FAWCETT (RPH)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:FAWCETT
Last Name:SUMMERELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42015 VILLAGE CENTER PLZ
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3033
Mailing Address - Country:US
Mailing Address - Phone:703-542-8344
Mailing Address - Fax:703-542-8351
Practice Address - Street 1:42015 VILLAGE CENTER PLZ
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:20105-3033
Practice Address - Country:US
Practice Address - Phone:703-542-8344
Practice Address - Fax:703-542-8351
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006806183500000X
GARPH011391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist