Provider Demographics
NPI:1558558296
Name:DE VERE, MELISSA MAE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MAE
Last Name:DE VERE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HUYARD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-1241
Mailing Address - Country:US
Mailing Address - Phone:717-354-2623
Mailing Address - Fax:
Practice Address - Street 1:1507 LITITZ PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6505
Practice Address - Country:US
Practice Address - Phone:717-585-3542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA441858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA441858OtherSTATE LICENSE