Provider Demographics
NPI:1285016808
Name:NELSON, MELISSA KAY (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 W LAKES PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8377
Mailing Address - Country:US
Mailing Address - Phone:877-219-1294
Mailing Address - Fax:515-241-7536
Practice Address - Street 1:1776 W LAKES PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8377
Practice Address - Country:US
Practice Address - Phone:877-219-1294
Practice Address - Fax:515-241-7536
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist