Provider Demographics
NPI:1821406380
Name:MELLAND-SCHROCK, ANGELLA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELLA
Middle Name:MARIE
Last Name:MELLAND-SCHROCK
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 1:5 JUANITA ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67505-2131
Mailing Address - Country:US
Mailing Address - Phone:620-474-6140
Mailing Address - Fax:
Practice Address - Street 1:5 JUANITA ST
Practice Address - Street 2:
Practice Address - City:SOUTH HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67505-2131
Practice Address - Country:US
Practice Address - Phone:620-474-6140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist