Provider Demographics
NPI:1184606345
Name:HOUSER, MELANIE D (RPH)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:D
Last Name:HOUSER
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 1:4640 GROOM RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-7255
Mailing Address - Country:US
Mailing Address - Phone:573-701-4055
Mailing Address - Fax:573-358-7450
Practice Address - Street 1:113 SAINT FRANCOIS PLZ
Practice Address - Street 2:
Practice Address - City:LEADINGTON
Practice Address - State:MO
Practice Address - Zip Code:63601-4454
Practice Address - Country:US
Practice Address - Phone:573-431-5040
Practice Address - Fax:573-431-8967
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001024749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600446504Medicaid