Individual
MELODY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
620 JOHN PAUL JONES CIR, NAVAL MEDICAL CENTER PORTSMOUTH, PORSTMOUTH, VA 23708-2370
(757) 953-0284
Mailing address
1 HIGH ST APT 415, PORTSMOUTH, VA 23704-3814
(757) 879-6955
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
0230023795
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0230023795
VIRGINIA BOARD OF PHARMACY
VA
Enumeration date
04/04/2018
Last updated
04/04/2018
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