MEDICARE: MS. MELINDA CORLEY RPH

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	1835X0200X	Oncology Pharmacist	2009023429	MO

General Provider Information

NPI Number	:	1861929713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELINDA CORLEY RPH

Provider Business Mailing Address
First Line	:	10 BARNES WEST DR
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6350
Country	:	US
Telephone Number	:	314-996-3403
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 BARNES WEST DR
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6350
Country	:	US
Telephone Number	:	314-996-3403
Fax Number	:

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

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	05/22/2017

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