Provider Demographics
NPI:1881295624
Name:FOSS, MELISSA (RPH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:FOSS
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 1:797 ROOSEVELT TRL
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5341
Mailing Address - Country:US
Mailing Address - Phone:207-892-8571
Mailing Address - Fax:207-892-6297
Practice Address - Street 1:797 ROOSEVELT TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5341
Practice Address - Country:US
Practice Address - Phone:207-892-8571
Practice Address - Fax:207-892-6297
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist