Healthcare Provider Details

I. General information

NPI: 1316251739
Provider Name (Legal Business Name): MELISSA BURBRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E JEFFERSON ST STE A
CORYDON IA
50060-1812
US

IV. Provider business mailing address

510 E JEFFERSON ST STE A
CORYDON IA
50060-1812
US

V. Phone/Fax

Practice location:
  • Phone: 641-872-2030
  • Fax: 641-872-2031
Mailing address:
  • Phone: 641-872-2030
  • Fax: 641-872-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18680
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: