Provider Demographics
NPI:1114403367
Name:SORIANO, MELISSA ANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:SORIANO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 US HIGHWAY 50 W
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-1938
Mailing Address - Country:US
Mailing Address - Phone:636-583-2110
Mailing Address - Fax:
Practice Address - Street 1:500 US HIGHWAY 50 W
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1938
Practice Address - Country:US
Practice Address - Phone:636-583-2110
Practice Address - Fax:636-583-1642
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015025622183500000X
IL051298721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist