Provider Demographics
NPI:1750618377
Name:PERSONS, AMY MELISSA (RPH)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MELISSA
Last Name:PERSONS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2173
Mailing Address - Country:US
Mailing Address - Phone:812-522-5409
Mailing Address - Fax:812-523-2300
Practice Address - Street 1:105 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2173
Practice Address - Country:US
Practice Address - Phone:812-522-5409
Practice Address - Fax:812-523-2300
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV6069183500000X
IN26024347A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist