Provider Demographics
NPI:1568745982
Name:MATTISON, MELISSA JEAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:MATTISON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-3911
Mailing Address - Country:US
Mailing Address - Phone:413-493-1860
Mailing Address - Fax:413-493-6577
Practice Address - Street 1:583 JAMES ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-3911
Practice Address - Country:US
Practice Address - Phone:413-493-1860
Practice Address - Fax:413-493-6577
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26577183500000X
CT8107183500000X
LA16129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist