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NPI Code Detail

MEDICARE: MRS. MELISSA DAWN BLUNDELL PHARMD

MEDICARE: MRS. MELISSA DAWN BLUNDELL 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
1183500000XPharmacist14737OK

General Provider Information

NPI Number : 1912294539
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELISSA DAWN BLUNDELL PHARMD
Provider Business Mailing Address
First Line : 9010 N 121ST EAST AVE
Second Line : T-2095
City : OWASSO
State : OK
Zip : 74055-5358
Country : US
Telephone Number : 918-401-8001
Fax Number : 918-401-8001
Provider Business Practice Location Address
First Line : 9010 N 121ST EAST AVE
Second Line : T-2095
City : OWASSO
State : OK
Zip : 74055-5358
Country : US
Telephone Number : 918-401-8001
Fax Number : 918-401-8001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2011
Last Update Date : 07/03/2011

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