Provider Demographics
NPI:1962006106
Name:STAWSKI, MELISSA NOEL (RPH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:NOEL
Last Name:STAWSKI
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 1:7820 NORTHGATE LOOP
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5777
Mailing Address - Country:US
Mailing Address - Phone:630-204-7675
Mailing Address - Fax:
Practice Address - Street 1:2674 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7104
Practice Address - Country:US
Practice Address - Phone:254-773-9953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist