Provider Demographics
NPI:1871826768
Name:LIDDELL, MELANIE BEVERLEE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:BEVERLEE
Last Name:LIDDELL
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 1:1992 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1021
Mailing Address - Country:US
Mailing Address - Phone:503-362-4845
Mailing Address - Fax:503-362-5137
Practice Address - Street 1:1992 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1021
Practice Address - Country:US
Practice Address - Phone:503-362-4845
Practice Address - Fax:503-362-5137
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0007520183500000X
OR75201835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist