Healthcare Provider Details

I. General information

NPI: 1568097004
Provider Name (Legal Business Name): MELISSA SARGENT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8661 N PORT WASHINGTON RD
FOX POINT WI
53217-2209
US

IV. Provider business mailing address

8661 N PORT WASHINGTON RD
FOX POINT WI
53217-2209
US

V. Phone/Fax

Practice location:
  • Phone: 414-540-6836
  • Fax:
Mailing address:
  • Phone: 414-540-6836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19921-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: