Provider Demographics
NPI:1982911384
Name:HEDGES, MELISA LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:LYNN
Last Name:HEDGES
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 1:139 MERCHANT PL
Mailing Address - Street 2:
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043-5715
Mailing Address - Country:US
Mailing Address - Phone:518-234-1090
Mailing Address - Fax:
Practice Address - Street 1:139 MERCHANT PL
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-5715
Practice Address - Country:US
Practice Address - Phone:518-234-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH2706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist