Provider Demographics
NPI:1457572422
Name:ANDERSON, MELISSA B (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:B
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 GAMBLERS CHOICE TRL
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-5804
Mailing Address - Country:US
Mailing Address - Phone:907-227-9379
Mailing Address - Fax:
Practice Address - Street 1:8235 GAMBLERS CHOICE TRL
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-5804
Practice Address - Country:US
Practice Address - Phone:907-227-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1611183500000X
LA11026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist