Provider Demographics
NPI:1992399844
Name:WINTER, MELISSA SUE (RPH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:WINTER
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 1:20206 HYATT LN
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-9448
Mailing Address - Country:US
Mailing Address - Phone:573-368-8797
Mailing Address - Fax:
Practice Address - Street 1:300 ICHORD AVE
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-3608
Practice Address - Country:US
Practice Address - Phone:573-774-8469
Practice Address - Fax:573-341-3986
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist