Provider Demographics
NPI:1194270546
Name:BORON, MELANIE (PHARMD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:BORON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5881 SOM CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-3036
Mailing Address - Country:US
Mailing Address - Phone:440-946-4357
Mailing Address - Fax:440-946-5329
Practice Address - Street 1:5881 SOM CENTER RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-3036
Practice Address - Country:US
Practice Address - Phone:440-946-4357
Practice Address - Fax:440-946-5329
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03234029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03234029OtherSTATE OF OHIO BOARD OF PHARMACY LICENSE