Provider Demographics
NPI:1538437876
Name:GEORGE, MELISSA GAYLE (PHAMD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAYLE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 ELM DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-2183
Mailing Address - Country:US
Mailing Address - Phone:317-203-5265
Mailing Address - Fax:
Practice Address - Street 1:7920 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-5632
Practice Address - Country:US
Practice Address - Phone:317-872-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021624A183500000X, 1835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear
No183500000XPharmacy Service ProvidersPharmacist