Provider Demographics
NPI:1689274037
Name:MELLOTT, VANESSA LYNN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:LYNN
Last Name:MELLOTT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:VANNESSA
Other - Middle Name:LYNN
Other - Last Name:MELLOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:6285 E WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-8121
Mailing Address - Country:US
Mailing Address - Phone:352-257-2353
Mailing Address - Fax:
Practice Address - Street 1:1936 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9680
Practice Address - Country:US
Practice Address - Phone:352-228-6003
Practice Address - Fax:352-228-6004
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist