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NPI Code Detail

MEDICARE: DR. MELISSA WAYNE MARTIN PHARMD

MEDICARE: DR. MELISSA WAYNE MARTIN 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
1183500000XPharmacist2015026777MO

General Provider Information

NPI Number : 1538769278
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MELISSA WAYNE MARTIN PHARMD
Provider Business Mailing Address
First Line : 221 N 3RD ST
Second Line :
City : THAYER
State : MO
Zip : 65791-1259
Country : US
Telephone Number : 417-280-7608
Fax Number :
Provider Business Practice Location Address
First Line : 1101 BRANSON HILLS PKWY
Second Line :
City : BRANSON
State : MO
Zip : 65616-9942
Country : US
Telephone Number : 417-334-2137
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2020
Last Update Date : 10/30/2020

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