Provider Demographics
NPI:1184995805
Name:NIEHUS, MELANIE MARIE (RPH)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:MARIE
Last Name:NIEHUS
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 1:1565 GLEN JULIA RD
Mailing Address - Street 2:
Mailing Address - City:CHATTAHOOCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32324-3482
Mailing Address - Country:US
Mailing Address - Phone:850-345-1464
Mailing Address - Fax:
Practice Address - Street 1:1565 GLEN JULIA RD
Practice Address - Street 2:
Practice Address - City:CHATTAHOOCHEE
Practice Address - State:FL
Practice Address - Zip Code:32324-3482
Practice Address - Country:US
Practice Address - Phone:850-345-1464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40155183500000X
OH03-1-20652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist