Provider Demographics
NPI:1861087587
Name:SURBAUGH, MELISSA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SURBAUGH
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 WILLOW RUN
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5701
Mailing Address - Country:US
Mailing Address - Phone:304-377-9001
Mailing Address - Fax:
Practice Address - Street 1:1000 CHESTNUT COMMONS DR
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-9602
Practice Address - Country:US
Practice Address - Phone:440-365-0135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist