Provider Demographics
NPI:1063027191
Name:MELBY, CASEY JACOB
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:JACOB
Last Name:MELBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 S BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-1646
Mailing Address - Country:US
Mailing Address - Phone:816-233-2532
Mailing Address - Fax:816-232-0066
Practice Address - Street 1:2620 S BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-1646
Practice Address - Country:US
Practice Address - Phone:816-233-2532
Practice Address - Fax:816-232-0066
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017029982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist