Provider Demographics
NPI:1902020175
Name:MELICK, GLEN MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:MICHAEL
Last Name:MELICK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6145 WATKINS RD SW
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-8452
Mailing Address - Country:US
Mailing Address - Phone:740-927-3136
Mailing Address - Fax:
Practice Address - Street 1:255 PHILLIPI RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1307
Practice Address - Country:US
Practice Address - Phone:614-278-5563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH033118291835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy