Provider Demographics
NPI:1649688060
Name:MUNDEN, MELYNDA JANE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MELYNDA
Middle Name:JANE
Last Name:MUNDEN
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 1:11301 BROOKLYN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-8485
Mailing Address - Country:US
Mailing Address - Phone:517-592-2475
Mailing Address - Fax:
Practice Address - Street 1:11301 BROOKLYN RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MI
Practice Address - Zip Code:49230-8485
Practice Address - Country:US
Practice Address - Phone:517-592-2475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302030350OtherSTATE OF MICHIGAN