Provider Demographics
NPI:1124327515
Name:JAMISON, MELVIN STUART (RPH)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:STUART
Last Name:JAMISON
Suffix:
Gender:M
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:PO BOX 230
Mailing Address - Street 2:
Mailing Address - City:SURVEYOR
Mailing Address - State:WV
Mailing Address - Zip Code:25932-0230
Mailing Address - Country:US
Mailing Address - Phone:304-934-6337
Mailing Address - Fax:304-934-6333
Practice Address - Street 1:6435C HARPER ROAD
Practice Address - Street 2:
Practice Address - City:SURVEYOR
Practice Address - State:WV
Practice Address - Zip Code:25932-0230
Practice Address - Country:US
Practice Address - Phone:304-934-6337
Practice Address - Fax:304-934-6333
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV5230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist