MEDICARE: MELISSA ANN VAIL 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PD08458	AR

General Provider Information

NPI Number	:	1336788074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANN VAIL PHARMD

Provider Business Mailing Address
First Line	:	6929 JOHN F KENNEDY BLVD STE 5
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-5397
Country	:	US
Telephone Number	:	501-835-6530
Fax Number	:	501-835-6531

Provider Business Practice Location Address
First Line	:	6929 JOHN F KENNEDY BLVD STE 5
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-5397
Country	:	US
Telephone Number	:	501-835-6530
Fax Number	:	501-835-6531

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

Provider Enumeration Date	:	12/28/2019
Last Update Date	:	02/18/2020

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