Provider Demographics
NPI:1639508286
Name:ROBERTS, MELANIE ANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ANNE
Last Name:ROBERTS
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 1:1800 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-4208
Mailing Address - Country:US
Mailing Address - Phone:417-532-7148
Mailing Address - Fax:417-532-2631
Practice Address - Street 1:1800 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-4208
Practice Address - Country:US
Practice Address - Phone:417-532-7148
Practice Address - Fax:417-532-2631
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist