Provider Demographics
NPI:1760811426
Name:CARTER, MELISSA H (PD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:H
Last Name:CARTER
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71646-3256
Mailing Address - Country:US
Mailing Address - Phone:870-831-6163
Mailing Address - Fax:888-385-2977
Practice Address - Street 1:113 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:AR
Practice Address - Zip Code:71646-3256
Practice Address - Country:US
Practice Address - Phone:870-831-6163
Practice Address - Fax:888-385-2977
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.013864183500000X
ARPD07317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist