MEDICARE: MS. DONNA MARIE MELLISON PHARMACIST MANAGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH00041310	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PH00041310	OTHER	WA	WA BOARD OF HEALTH

General Provider Information

NPI Number	:	1285982736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA MARIE MELLISON PHARMACIST MANAGER

Provider Business Mailing Address
First Line	:	1340 N WENATCHEE AVE
Second Line	:
City	:	WENATCHEE
State	:	WA
Zip	:	98801-1558
Country	:	US
Telephone Number	:	509-664-5111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 N WENATCHEE AVE
Second Line	:
City	:	WENATCHEE
State	:	WA
Zip	:	98801-1558
Country	:	US
Telephone Number	:	509-664-5111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	11/02/2016

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