Provider Demographics
NPI:1538349246
Name:MELLOR, JOHN R JR (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:MELLOR
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 SANFORD FARMS SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7535
Mailing Address - Country:US
Mailing Address - Phone:518-843-8332
Mailing Address - Fax:518-843-8334
Practice Address - Street 1:141 SANFORD FARMS SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7535
Practice Address - Country:US
Practice Address - Phone:518-843-8332
Practice Address - Fax:518-843-8334
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist