Healthcare Provider Details

I. General information

NPI: 1497716641
Provider Name (Legal Business Name): MELANIE BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 10TH ST SE
CEDAR RAPIDS IA
52403-2441
US

IV. Provider business mailing address

2444 5TH AVE SE
CEDAR RAPIDS IA
52403-2959
US

V. Phone/Fax

Practice location:
  • Phone: 319-363-1284
  • Fax: 319-363-4453
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18952
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: