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General NPI Number Information
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NPI Number | 1891398681
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Entity Type | Individual
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Provider Name | MELISSA GAUDA
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Gender | Female
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 2015 FAYETTEVILLE RD
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City | VAN BUREN
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State | AR
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Zip | 72956-6537
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Country | US
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Telephone | 479-471-1608
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Fax | 479-471-1658
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Provider Business Mailing Address
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Address Line | 706 SW STERLING PL
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City | BENTONVILLE
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State | AR
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Zip | 72712-7773
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Country | US
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Telephone | 716-225-1597
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD13441
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License Number State | AR
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