Provider Demographics
NPI:1912509019
Name:THAI, MELISSA BAO TRAN
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:BAO TRAN
Last Name:THAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BLUE HILL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-5205
Mailing Address - Country:US
Mailing Address - Phone:617-953-8420
Mailing Address - Fax:
Practice Address - Street 1:31 BLUE HILL RIVER RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5205
Practice Address - Country:US
Practice Address - Phone:617-953-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist