MEDICARE: DR. MELISSA ANNE HOLZHAUER PHARMD

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	057990-1	NY
2	183500000X	Pharmacist	0012994	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0012994	OTHER	OR	OREGON STATE PHARMACIST LICENSE NUMBER
2	057990-1	OTHER	NY	NEW YORK STATE PHARMACIST LICENSE NUMBER

General Provider Information

NPI Number	:	1336429794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA ANNE HOLZHAUER PHARMD

Provider Business Mailing Address
First Line	:	112 NEW YORK RD
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-3933
Country	:	US
Telephone Number	:	518-562-3380
Fax Number	:	518-562-9751

Provider Business Practice Location Address
First Line	:	112 NEW YORK RD
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-3933
Country	:	US
Telephone Number	:	518-562-3380
Fax Number	:	518-562-9751

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

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	07/08/2013

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