Provider Demographics
NPI:1265916043
Name:WEST, MELISSA KAYE (RPH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAYE
Last Name:WEST
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KAYE
Other - Last Name:OLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 SE SALEM ST
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:64075-9284
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 SE SALEM ST
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-9284
Practice Address - Country:US
Practice Address - Phone:816-690-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004034220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2004034220OtherMISSOURI STATE LICENSE NUMBER