Provider Demographics
NPI:1720617509
Name:ADRIAN, MELISSA (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:ADRIAN
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:IA
Mailing Address - Zip Code:52585-0183
Mailing Address - Country:US
Mailing Address - Phone:319-653-1763
Mailing Address - Fax:
Practice Address - Street 1:1300 W BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2766
Practice Address - Country:US
Practice Address - Phone:319-653-1763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA198583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19858OtherPHARMACIST LICENSE NUMBER