Provider Demographics
NPI:1407178239
Name:COVINGTON DE EID, MELISSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:COVINGTON DE EID
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 NW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3704
Mailing Address - Country:US
Mailing Address - Phone:580-355-7124
Mailing Address - Fax:
Practice Address - Street 1:1050 NW 38TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3704
Practice Address - Country:US
Practice Address - Phone:580-355-7124
Practice Address - Fax:580-357-1383
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-21
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist