Provider Demographics
NPI:1811298128
Name:MACCIA, MELISSA DICKERSON (PHARMD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DICKERSON
Last Name:MACCIA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:BETH
Other - Last Name:DICKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1126 N CHURCH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1037
Mailing Address - Country:US
Mailing Address - Phone:336-938-0717
Mailing Address - Fax:336-938-0757
Practice Address - Street 1:1126 N CHURCH ST STE 300
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1037
Practice Address - Country:US
Practice Address - Phone:336-938-0717
Practice Address - Fax:336-938-0757
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist