Provider Demographics
NPI:1881081495
Name:POLLEY, MELANIE (PHARMD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:POLLEY
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 1:2360 LANSING DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-6471
Mailing Address - Country:US
Mailing Address - Phone:816-935-6434
Mailing Address - Fax:
Practice Address - Street 1:505 BOYSON RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-7284
Practice Address - Country:US
Practice Address - Phone:319-294-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21578183500000X
MO2007022156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist