Melissa Crockett Gulley, PHARM D.
Individual provider Active NPI Pharmacist · Middlesboro, KY
NPI 1043336092 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1043336092
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 011676 (KY)
- Practice address
- 102 N 12TH St
Middlesboro, KY 40965-1028 - Phone
- (606) 248-7689
- NPI assigned
- Mar 21, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011676 | KY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| K VA T Food Stores Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 011676 | KY | Yes |
Addresses
Primary practice location
102 N 12TH St
Middlesboro, KY 40965-1028
Mailing address
1315 Chester Avenue
Middlesboro, KY 40965
Other providers in Middlesboro, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.