Provider Demographics
NPI:1770184004
Name:BOCOCK, MELISSA ANN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:BOCOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 COURTLAND DR
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:OH
Mailing Address - Zip Code:43028-9001
Mailing Address - Country:US
Mailing Address - Phone:740-398-1119
Mailing Address - Fax:
Practice Address - Street 1:1575 COSHOCTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1476
Practice Address - Country:US
Practice Address - Phone:740-392-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03125674183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist