Provider Demographics
NPI:1083941140
Name:REDPATH, MELINDA L
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:L
Last Name:REDPATH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:REDPATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:606 ENNIS AVE.
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119
Mailing Address - Country:US
Mailing Address - Phone:972-875-5996
Mailing Address - Fax:
Practice Address - Street 1:606 W ENNIS AVE
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-3806
Practice Address - Country:US
Practice Address - Phone:972-875-5996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25632183500000X
TXTX256321835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist