Provider Demographics
NPI:1275019291
Name:MELIZA, DANA MICHELLE (RPH)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:MICHELLE
Last Name:MELIZA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19823 74TH ST
Mailing Address - Street 2:
Mailing Address - City:MC LOUTH
Mailing Address - State:KS
Mailing Address - Zip Code:66054-4234
Mailing Address - Country:US
Mailing Address - Phone:913-796-6787
Mailing Address - Fax:
Practice Address - Street 1:5000 10TH AVE
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5514
Practice Address - Country:US
Practice Address - Phone:913-250-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-12724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist