Provider Demographics
NPI:1629549712
Name:BAIRD, MELISSA LEE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEE
Last Name:BAIRD
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 1:402 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-3949
Mailing Address - Country:US
Mailing Address - Phone:903-572-6337
Mailing Address - Fax:
Practice Address - Street 1:402 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-3949
Practice Address - Country:US
Practice Address - Phone:903-572-6337
Practice Address - Fax:903-572-7455
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist