Provider Demographics
NPI:1982970570
Name:JAMESON, MELODY ANN
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:ANN
Last Name:JAMESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12105 229TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7821
Mailing Address - Country:US
Mailing Address - Phone:253-862-1444
Mailing Address - Fax:
Practice Address - Street 1:1201 39TH AVE SW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3803
Practice Address - Country:US
Practice Address - Phone:253-445-7542
Practice Address - Fax:253-445-7549
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00040727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist