Provider Demographics
NPI:1801268123
Name:VERTLIEB, MELINDA RENEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:RENEE
Last Name:VERTLIEB
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:RENEE
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1221 E CHURCHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3411
Mailing Address - Country:US
Mailing Address - Phone:410-420-8319
Mailing Address - Fax:
Practice Address - Street 1:1221 E CHURCHVILLE RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3411
Practice Address - Country:US
Practice Address - Phone:410-420-8319
Practice Address - Fax:410-420-9068
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist