Provider Demographics
NPI:1134725070
Name:EBOKAH, MELISSA (RPH)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:EBOKAH
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 1:31640 FAIRHILL DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-7013
Mailing Address - Country:US
Mailing Address - Phone:813-850-8877
Mailing Address - Fax:
Practice Address - Street 1:31640 FAIRHILL DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-7013
Practice Address - Country:US
Practice Address - Phone:813-850-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS45897OtherFLORIDA BOARD OF PHARMACY