Provider Demographics
NPI:1902010598
Name:STORCK, MELISSA R (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:STORCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 GULF BLVD
Mailing Address - Street 2:#907
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33767-2875
Mailing Address - Country:US
Mailing Address - Phone:813-368-7753
Mailing Address - Fax:
Practice Address - Street 1:1921 N BELCHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-4548
Practice Address - Country:US
Practice Address - Phone:727-726-2787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist