Provider Demographics
NPI:1356895437
Name:NICOLAY, MELANIE ANNE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:ANNE
Last Name:NICOLAY
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 1:2119 SYLVIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT BERNARD
Mailing Address - State:LA
Mailing Address - Zip Code:70085-5148
Mailing Address - Country:US
Mailing Address - Phone:504-554-3535
Mailing Address - Fax:
Practice Address - Street 1:2119 SYLVIA BLVD
Practice Address - Street 2:
Practice Address - City:SAINT BERNARD
Practice Address - State:LA
Practice Address - Zip Code:70085-5148
Practice Address - Country:US
Practice Address - Phone:504-554-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-07
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021611183500000X
MSE14602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist