Provider Demographics
NPI:1720427941
Name:MAST, MELINDA K (PHARM D)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:K
Last Name:MAST
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14280 W TEEL RD
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-7857
Mailing Address - Country:US
Mailing Address - Phone:918-645-1536
Mailing Address - Fax:918-227-6109
Practice Address - Street 1:1329 S MAIN ST UNIT C
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-5505
Practice Address - Country:US
Practice Address - Phone:918-512-6635
Practice Address - Fax:918-512-6638
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200458560AMedicaid