| NPI | 1801143680 |
|---|---|
| Former Name | MICHELLE C MELLON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 71103) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 51966) |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2017-04-26 |