Provider Demographics
NPI:1689101719
Name:AAMODT, MELINDA SUE (RPH)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:AAMODT
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 1:124 HIDDEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-8068
Mailing Address - Country:US
Mailing Address - Phone:614-313-1028
Mailing Address - Fax:
Practice Address - Street 1:800 W COSHOCTON ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-8904
Practice Address - Country:US
Practice Address - Phone:740-966-8310
Practice Address - Fax:740-966-8312
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03124390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist