Provider Demographics
NPI:1851401327
Name:PAMMER, MELISSA JO (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JO
Last Name:PAMMER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:57950 LEAVENWORTH ST
Mailing Address - Street 2:22 MDSS/SGSAP
Mailing Address - City:MCCONNELL AFB
Mailing Address - State:KS
Mailing Address - Zip Code:67221-3506
Mailing Address - Country:US
Mailing Address - Phone:316-759-5509
Mailing Address - Fax:316-759-5038
Practice Address - Street 1:57950 LEAVENWORTH ST
Practice Address - Street 2:22 MDSS/SGSAP
Practice Address - City:MCCONNELL AFB
Practice Address - State:KS
Practice Address - Zip Code:67221-3506
Practice Address - Country:US
Practice Address - Phone:316-759-5509
Practice Address - Fax:316-759-5038
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARP045741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist