Provider Demographics
NPI:1952057960
Name:SMITH, MELISSA ANN
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-2613
Mailing Address - Country:US
Mailing Address - Phone:979-942-3584
Mailing Address - Fax:979-429-4075
Practice Address - Street 1:4901 MISTY LN APT 603
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-8457
Practice Address - Country:US
Practice Address - Phone:979-942-3584
Practice Address - Fax:979-429-4075
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183700000X
TX117940183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician