MEDICARE: MELISSA GAUDA

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	PD13441	AR

General Provider Information

NPI Number	:	1891398681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA GAUDA

Provider Business Mailing Address
First Line	:	706 SW STERLING PL
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72712-7773
Country	:	US
Telephone Number	:	716-225-1597
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 FAYETTEVILLE RD
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956-6537
Country	:	US
Telephone Number	:	479-471-1608
Fax Number	:	479-471-1658

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

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	11/16/2020

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Directions to “ MELISSA GAUDA ” Practice Location

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