Individual
ETHAN MELILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
335 PRAIRIE AVE, PROVIDENCE, RI 02905-1924
(401) 781-4325
Mailing address
335 PRAIRIE AVE, PROVIDENCE, RI 02905-1924
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH05855
RI
Other
Enumeration date
09/02/2020
Last updated
09/02/2020
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