Provider Demographics
NPI:1639625619
Name:SHELDEN, MELANIE RENEE
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:RENEE
Last Name:SHELDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:RENEE
Other - Last Name:PECKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1868 COVE RD
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-5368
Mailing Address - Country:US
Mailing Address - Phone:208-899-6091
Mailing Address - Fax:
Practice Address - Street 1:208 W IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2640
Practice Address - Country:US
Practice Address - Phone:208-664-3185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP7555183500000X
WAPH60658273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist