Provider Demographics
NPI:1124396239
Name:BAXTER, MELISSA S (PHARMD, BCPS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:S
Last Name:BAXTER
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 WEHRLE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7750
Mailing Address - Country:US
Mailing Address - Phone:716-631-3381
Mailing Address - Fax:
Practice Address - Street 1:1142 WEHRLE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7750
Practice Address - Country:US
Practice Address - Phone:716-631-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-03
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0496861835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist