Provider Demographics
NPI:1518482819
Name:CLARK, MELEA HOPELYN (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MELEA
Middle Name:HOPELYN
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5670 WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-8303
Mailing Address - Country:US
Mailing Address - Phone:850-758-7851
Mailing Address - Fax:
Practice Address - Street 1:2180 W NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-9472
Practice Address - Country:US
Practice Address - Phone:850-473-5025
Practice Address - Fax:850-473-5031
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist