Provider Demographics
NPI:1003181835
Name:MELODY PHARMACY INC
Entity type:Organization
Organization Name:MELODY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, RPH
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EGBERONGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-625-0018
Mailing Address - Street 1:17639 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4007
Mailing Address - Country:US
Mailing Address - Phone:305-625-0018
Mailing Address - Fax:305-625-0020
Practice Address - Street 1:17639 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-4007
Practice Address - Country:US
Practice Address - Phone:305-625-0018
Practice Address - Fax:305-625-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH260443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134690OtherPK
FL000000000Medicaid