Provider Demographics
NPI:1770618415
Name:SISTRUNK, MELANIE GRACE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:GRACE
Last Name:SISTRUNK
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 1:2000 PEPPERELL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-1026
Mailing Address - Country:US
Mailing Address - Phone:334-528-2270
Mailing Address - Fax:
Practice Address - Street 1:2000 PEPPERELL PKWY
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5452
Practice Address - Country:US
Practice Address - Phone:334-528-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13777183500000X
GARPH021200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist