Provider Demographics
NPI:1619176567
Name:DEGEETER, MELISSA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:M
Last Name:DEGEETER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:E
Other - Last Name:MALLORCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:127 E OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3154
Mailing Address - Country:US
Mailing Address - Phone:630-357-1040
Mailing Address - Fax:630-357-1431
Practice Address - Street 1:127 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3154
Practice Address - Country:US
Practice Address - Phone:630-357-1040
Practice Address - Fax:630-357-1431
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51287878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist