Provider Demographics
NPI:1558657486
Name:INCE, MELISSA J (RPH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:INCE
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 1:7427 GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1910
Mailing Address - Country:US
Mailing Address - Phone:662-895-1956
Mailing Address - Fax:662-895-9576
Practice Address - Street 1:7427 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-1910
Practice Address - Country:US
Practice Address - Phone:662-895-1956
Practice Address - Fax:662-895-9576
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-0106481835P0018X
TN6805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist