Provider Demographics
NPI:1972841773
Name:INGRAHAM, MELINDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:INGRAHAM
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 1:4300 SPRING MEADOW PL NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52411-6666
Mailing Address - Country:US
Mailing Address - Phone:319-721-7582
Mailing Address - Fax:
Practice Address - Street 1:5070 ROCKWELL DR NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2003
Practice Address - Country:US
Practice Address - Phone:319-377-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist