Provider Demographics
NPI:1992775522
Name:STANLEY, MELISSA BETH (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:BETH
Last Name:STANLEY
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 1:1500 SPARTA ST
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1317
Mailing Address - Country:US
Mailing Address - Phone:931-473-4471
Mailing Address - Fax:931-473-2217
Practice Address - Street 1:1500 SPARTA ST
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1317
Practice Address - Country:US
Practice Address - Phone:931-473-4471
Practice Address - Fax:931-473-2217
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist