Provider Demographics
NPI:1841893401
Name:ANTOSCA, MELANIE M (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:M
Last Name:ANTOSCA
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 1:160 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1226
Mailing Address - Country:US
Mailing Address - Phone:781-582-3703
Mailing Address - Fax:844-411-6349
Practice Address - Street 1:160 SUMMER ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1226
Practice Address - Country:US
Practice Address - Phone:781-582-3703
Practice Address - Fax:844-411-6349
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist