Provider Demographics
NPI:1700471521
Name:ELDER, MELODY DENISE (DPH)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:DENISE
Last Name:ELDER
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:MRS
Other - First Name:MELODY
Other - Middle Name:DENISE
Other - Last Name:DOWNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPH
Mailing Address - Street 1:608 NW 9TH ST STE 3200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1006
Mailing Address - Country:US
Mailing Address - Phone:405-815-5655
Mailing Address - Fax:
Practice Address - Street 1:608 NW 9TH ST STE 3200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1006
Practice Address - Country:US
Practice Address - Phone:405-815-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist