Provider Demographics
NPI:1750603940
Name:JANNOTTE, MELISSA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:JANNOTTE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106 WOODLANDS TRL
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2871
Mailing Address - Country:US
Mailing Address - Phone:631-806-2359
Mailing Address - Fax:
Practice Address - Street 1:20877 HALL RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-4256
Practice Address - Country:US
Practice Address - Phone:586-464-1129
Practice Address - Fax:586-464-1139
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050213183500000X
MI5302412646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist