Provider Demographics
NPI:1164287702
Name:OGLESBY, MELEONY ANN
Entity Type:Individual
Prefix:
First Name:MELEONY
Middle Name:ANN
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 LR 129
Mailing Address - Street 2:
Mailing Address - City:FOREMAN
Mailing Address - State:AR
Mailing Address - Zip Code:71836-8522
Mailing Address - Country:US
Mailing Address - Phone:903-276-6233
Mailing Address - Fax:
Practice Address - Street 1:1310 S CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-8652
Practice Address - Country:US
Practice Address - Phone:870-898-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist