Provider Demographics
NPI:1912882887
Name:ATIEH, MELISSA J (DAC, PHARMD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:J
Last Name:ATIEH
Suffix:
Gender:F
Credentials:DAC, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11558 ANISE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-5101
Mailing Address - Country:US
Mailing Address - Phone:312-371-1424
Mailing Address - Fax:
Practice Address - Street 1:19070 EVERETT BLVD UNIT 102
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-2073
Practice Address - Country:US
Practice Address - Phone:312-371-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.289439183500000X
IL198.001690171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No183500000XPharmacy Service ProvidersPharmacist