Individual provider Active NPI

Mellie Rose Vann

  • Pharmacist
  • Virginia Beach, VA
National Provider Identifier
1184259921
Registry record updated Mar 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
0202216011 Issued in VA
Practice address
1750 Tomcat Blvd
Virginia Beach, VA 23460-2168
Phone
(757) 953-3933
NPI assigned
Mar 11, 2020
Last updated
Mar 11, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 0202216011 VA Primary

Addresses

Primary practice location

1750 Tomcat Blvd
Virginia Beach, VA 23460-2168

Mailing address

5340 Hayton Way
Virginia Beach, VA 23455-2579
Phone (941) 448-9469

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
0202216011VAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583884800000",
    "number": "1184259921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5340 HAYTON WAY",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234552579",
            "telephone_number": "941-448-9469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 TOMCAT BLVD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234602168",
            "telephone_number": "757-953-3933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANN",
        "first_name": "MELLIE ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-11",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "0202216011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.