Provider Demographics
NPI:1205125689
Name:MASSENGILL, MELANIE MURPHREE
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:MURPHREE
Last Name:MASSENGILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 COUNTY ROAD 64 N
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-8916
Mailing Address - Country:US
Mailing Address - Phone:662-538-0769
Mailing Address - Fax:
Practice Address - Street 1:205 STATE HIGHWAY 30 W
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3111
Practice Address - Country:US
Practice Address - Phone:662-534-8181
Practice Address - Fax:662-534-6255
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE08821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist