Basic Information
| Provider Information | |||||||||
| NPI: | 1053372086 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MELNYK | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 704 GOLF HOUSE RD W | ||||||||
| Address2: | |||||||||
| City: | STONEY CREEK | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273779272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192860411 | ||||||||
| FaxNumber: | 9194165835 | ||||||||
| Practice Location | |||||||||
| Address1: | 508 FULTON ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277053875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192860411 | ||||||||
| FaxNumber: | 9194165835 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 14926 | NC | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
ID Information
| ID | Type | State | Issuer | Description | 14926 | 01 | NC | PHARMACY LICENSE | OTHER |