Provider Demographics
NPI:1477838902
Name:HOLOUS-MURPHY, MELISSA A
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:HOLOUS-MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 S VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-2771
Mailing Address - Country:US
Mailing Address - Phone:630-688-5496
Mailing Address - Fax:630-627-9792
Practice Address - Street 1:225 E ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4555
Practice Address - Country:US
Practice Address - Phone:630-627-9784
Practice Address - Fax:630-627-9792
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362127039478Medicaid