Provider Demographics
NPI:1942581830
Name:TEVLIN, MELISSA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:TEVLIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7422 HIGHWAY N
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7013
Mailing Address - Country:US
Mailing Address - Phone:636-625-5012
Mailing Address - Fax:
Practice Address - Street 1:7422 HIGHWAY N
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7013
Practice Address - Country:US
Practice Address - Phone:636-625-5012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009016859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist