Provider Demographics
NPI:1881984078
Name:BLACKBURN, MELISSA J (RPH)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:J
Last Name:BLACKBURN
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 1:320 CUTTERS HILL CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9426
Mailing Address - Country:US
Mailing Address - Phone:859-263-9506
Mailing Address - Fax:
Practice Address - Street 1:3120 PIMLICO PKWY
Practice Address - Street 2:PARK HILLS SHOPPING CENTER
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4034
Practice Address - Country:US
Practice Address - Phone:869-273-7963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist