Provider Demographics
NPI:1083017198
Name:FISHER, MELINDA MAY (DPH)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:MAY
Last Name:FISHER
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16640 SW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-9147
Mailing Address - Country:US
Mailing Address - Phone:405-820-2002
Mailing Address - Fax:405-567-4883
Practice Address - Street 1:1000 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864-4501
Practice Address - Country:US
Practice Address - Phone:405-567-4000
Practice Address - Fax:405-567-4883
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10738183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist