Provider Demographics
NPI:1205881679
Name:EPPS, MELISSA JEAN (RPA)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JEAN
Last Name:EPPS
Suffix:
Gender:F
Credentials:RPA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JEAN
Other - Last Name:OLIVERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 E BEACON HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-1711
Mailing Address - Country:US
Mailing Address - Phone:618-882-5625
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:ST LOUIS CHILDREN OUT PATIENT PHARMACY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6123
Practice Address - Fax:314-454-4374
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001000220183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist