Provider Demographics
NPI:1699068346
Name:MELLACE, SALVATORE JR
Entity type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:
Last Name:MELLACE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-3092
Mailing Address - Country:US
Mailing Address - Phone:508-990-3875
Mailing Address - Fax:508-997-7503
Practice Address - Street 1:676 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:SOUTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02748-3092
Practice Address - Country:US
Practice Address - Phone:508-990-3875
Practice Address - Fax:508-997-7503
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist