Provider Demographics
NPI:1033120217
Name:SANDERS, MELISSA RAINES (PHARM D)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RAINES
Last Name:SANDERS
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 1:891 PECAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-6493
Mailing Address - Country:US
Mailing Address - Phone:254-554-0549
Mailing Address - Fax:
Practice Address - Street 1:2511 TRIMMIER RD STE 100
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-1910
Practice Address - Country:US
Practice Address - Phone:254-634-2370
Practice Address - Fax:254-634-7185
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist