Provider Demographics
NPI:1104132984
Name:CYRUS, MELODIE MARIE (PHARM-D)
Entity type:Individual
Prefix:DR
First Name:MELODIE
Middle Name:MARIE
Last Name:CYRUS
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WALTON ST
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44880
Mailing Address - Country:US
Mailing Address - Phone:419-935-3900
Mailing Address - Fax:
Practice Address - Street 1:4 WALTON ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44880
Practice Address - Country:US
Practice Address - Phone:419-935-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03328829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist