Provider Demographics
NPI:1467700773
Name:MELQUIST, CHANTTEL T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHANTTEL
Middle Name:T
Last Name:MELQUIST
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 1:3800 LEXINGTON AVE N
Mailing Address - Street 2:T-0619
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-2916
Mailing Address - Country:US
Mailing Address - Phone:651-486-3883
Mailing Address - Fax:
Practice Address - Street 1:3800 LEXINGTON AVE N
Practice Address - Street 2:T-0619
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-2916
Practice Address - Country:US
Practice Address - Phone:651-486-3883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist