Provider Demographics
NPI:1235281833
Name:MELBY, KEVIN NEAL (RPH)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:NEAL
Last Name:MELBY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:NEAL
Other - Last Name:MELBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:618 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-2202
Mailing Address - Country:US
Mailing Address - Phone:715-246-7736
Mailing Address - Fax:
Practice Address - Street 1:110 W 4TH ST
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1722
Practice Address - Country:US
Practice Address - Phone:715-246-2186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12784183500000X
MN115867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist