Provider Demographics
NPI:1053597443
Name:CLOUGH, MELANIE (RPH)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 UTICA ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-1100
Mailing Address - Country:US
Mailing Address - Phone:315-824-2200
Mailing Address - Fax:
Practice Address - Street 1:103 UTICA ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1100
Practice Address - Country:US
Practice Address - Phone:315-824-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist