Healthcare Provider Details

I. General information

NPI: 1295355683
Provider Name (Legal Business Name): MELANIE PLANTENGA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2020
Last Update Date: 04/26/2020
Certification Date: 04/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 N MERIDIAN ST STE B106
CARMEL IN
46032-4656
US

IV. Provider business mailing address

10882 LANTERN VIEW DR APT 103
FISHERS IN
46038-4212
US

V. Phone/Fax

Practice location:
  • Phone: 317-688-3035
  • Fax:
Mailing address:
  • Phone: 765-404-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26028324A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: