Provider Demographics
NPI:1053602490
Name:WHITT, MELISSA D (RPH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:WHITT
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 1:415 N LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-1610
Mailing Address - Country:US
Mailing Address - Phone:270-358-3186
Mailing Address - Fax:270-358-0926
Practice Address - Street 1:415 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:HODGENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42748-1610
Practice Address - Country:US
Practice Address - Phone:270-358-3186
Practice Address - Fax:270-358-0926
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist