Provider Demographics
NPI:1942587324
Name:NEUBAUER, MELISSA SUE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:SUE
Last Name:NEUBAUER
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 1:450 S SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-2080
Mailing Address - Country:US
Mailing Address - Phone:815-485-7294
Mailing Address - Fax:815-485-7326
Practice Address - Street 1:450 S SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2080
Practice Address - Country:US
Practice Address - Phone:815-485-7294
Practice Address - Fax:815-485-7326
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-13
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist