Healthcare Provider Details

I. General information

NPI: 1912631995
Provider Name (Legal Business Name): MELODY ANN SHIPMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 S CAMPBELL AVE
SPRINGFIELD MO
65807-3632
US

IV. Provider business mailing address

900 S NATALIE AVE
SPRINGFIELD MO
65802-9701
US

V. Phone/Fax

Practice location:
  • Phone: 417-890-7924
  • Fax:
Mailing address:
  • Phone: 141-776-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2022027382
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: