Provider Demographics
NPI:1164718086
Name:PENFOLD, MELINDA KAY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:KAY
Last Name:PENFOLD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 4TH ST SW
Mailing Address - Street 2:T0804
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1501
Mailing Address - Country:US
Mailing Address - Phone:641-423-1325
Mailing Address - Fax:641-423-1325
Practice Address - Street 1:3450 4TH ST SW
Practice Address - Street 2:T0804
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1501
Practice Address - Country:US
Practice Address - Phone:641-423-1325
Practice Address - Fax:641-423-1325
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist