Provider Demographics
NPI:1053911727
Name:DAGRACA, MELISSA ANNE
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANNE
Last Name:DAGRACA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WEST JERSEY STREET
Mailing Address - Street 2:APT 314
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202
Mailing Address - Country:US
Mailing Address - Phone:908-578-9857
Mailing Address - Fax:
Practice Address - Street 1:400 PARK PL
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3654
Practice Address - Country:US
Practice Address - Phone:201-325-9275
Practice Address - Fax:201-325-9287
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03085600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist