Provider Demographics
NPI:1902413602
Name:MCMAHON, MELISSA JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:MCMAHON
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 1:2145 INGLEWOOD DR APT 213
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-2789
Mailing Address - Country:US
Mailing Address - Phone:703-909-2275
Mailing Address - Fax:
Practice Address - Street 1:2145 INGLEWOOD DR APT 213
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2789
Practice Address - Country:US
Practice Address - Phone:703-909-2275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202217016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist