Provider Demographics
NPI:1700060225
Name:SECOR, MELISSA JUNE (RPH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JUNE
Last Name:SECOR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JUNE
Other - Last Name:YURCHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:139 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-2148
Mailing Address - Country:US
Mailing Address - Phone:845-691-2708
Mailing Address - Fax:845-229-4319
Practice Address - Street 1:1 CRUM ELBOW RD
Practice Address - Street 2:BOX 234
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-2806
Practice Address - Country:US
Practice Address - Phone:845-229-4312
Practice Address - Fax:845-229-4319
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist