Provider Demographics
NPI:1295375533
Name:GREENE, MELISSA M (PHARMD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:GREENE
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 1:6725 DICK FLYNN BLVD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:OH
Mailing Address - Zip Code:45122-8025
Mailing Address - Country:US
Mailing Address - Phone:513-722-7460
Mailing Address - Fax:
Practice Address - Street 1:6725 DICK FLYNN BLVD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:OH
Practice Address - Zip Code:45122-8025
Practice Address - Country:US
Practice Address - Phone:513-722-7460
Practice Address - Fax:513-722-7495
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0170231835P0018X
OH033336641835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist