Provider Demographics
NPI:1609176247
Name:MELDER, FRED LEE SR (PD)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:LEE
Last Name:MELDER
Suffix:SR
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 MALCOLM AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-3623
Mailing Address - Country:US
Mailing Address - Phone:870-523-9228
Mailing Address - Fax:870-523-8502
Practice Address - Street 1:1705 MALCOLM AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3623
Practice Address - Country:US
Practice Address - Phone:870-523-9228
Practice Address - Fax:870-523-8502
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR183500000X183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist