Provider Demographics
NPI:1609975648
Name:DE REYNA, MELISSA BAILEY (PHARM D)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:BAILEY
Last Name:DE REYNA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:216 JUNIPER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7492
Mailing Address - Country:US
Mailing Address - Phone:504-400-0165
Mailing Address - Fax:
Practice Address - Street 1:4024 W LAKE MARY BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3349
Practice Address - Country:US
Practice Address - Phone:407-549-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-010333183500000X
LA166211835P1200X
FLPS63686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy