Provider Demographics
NPI:1518269166
Name:DEFIBAUGH, MELISSA HINES (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:HINES
Last Name:DEFIBAUGH
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:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26280-0087
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 11TH ST
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3765
Practice Address - Country:US
Practice Address - Phone:304-636-6938
Practice Address - Fax:304-696-7037
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist