Provider Demographics
NPI:1013239318
Name:STEWART, MELISSA MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:STEWART
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 1:5126 BRIERCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3436
Mailing Address - Country:US
Mailing Address - Phone:716-725-4150
Mailing Address - Fax:
Practice Address - Street 1:3882 S PARK AVE
Practice Address - Street 2:
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219-1812
Practice Address - Country:US
Practice Address - Phone:716-825-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-28
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052912-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist