Provider Demographics
NPI:1851057897
Name:MANYASA, MELISSA (PHARM D)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MANYASA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:10 POPES LN
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1411
Mailing Address - Country:US
Mailing Address - Phone:978-257-2753
Mailing Address - Fax:
Practice Address - Street 1:55 BROOKSBY VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1444
Practice Address - Country:US
Practice Address - Phone:978-777-6983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH27590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist