Provider Demographics
NPI:1417443813
Name:MITCHENER, MELANIE KAY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:KAY
Last Name:MITCHENER
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 1:150 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-3749
Mailing Address - Country:US
Mailing Address - Phone:309-853-8000
Mailing Address - Fax:
Practice Address - Street 1:150 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-3749
Practice Address - Country:US
Practice Address - Phone:309-853-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-040138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist