Provider Demographics
NPI:1902143993
Name:BLAWN, MELANIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:BLAWN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 N COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-2629
Mailing Address - Country:US
Mailing Address - Phone:321-986-6393
Mailing Address - Fax:321-986-6268
Practice Address - Street 1:1850 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-2629
Practice Address - Country:US
Practice Address - Phone:321-986-6393
Practice Address - Fax:321-986-6268
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist