Provider Demographics
NPI:1396165262
Name:SHEALY, MELANIE H (RPH)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:H
Last Name:SHEALY
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 1:2812 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-4134
Mailing Address - Country:US
Mailing Address - Phone:803-276-2211
Mailing Address - Fax:803-276-7720
Practice Address - Street 1:2812 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-4134
Practice Address - Country:US
Practice Address - Phone:803-276-2211
Practice Address - Fax:803-276-7720
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC008848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist