Provider Demographics
NPI:1851601934
Name:WILMOTH, MELISSA F (RPH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:F
Last Name:WILMOTH
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 1:3211 MASON LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-0337
Mailing Address - Country:US
Mailing Address - Phone:478-278-0243
Mailing Address - Fax:478-296-1448
Practice Address - Street 1:122 HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-6340
Practice Address - Country:US
Practice Address - Phone:478-296-1773
Practice Address - Fax:478-296-1448
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist