Provider Demographics
NPI:1144506189
Name:PLUMELY, MELISSA BETH
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:BETH
Last Name:PLUMELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 DINO ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7278
Mailing Address - Country:US
Mailing Address - Phone:501-625-3869
Mailing Address - Fax:
Practice Address - Street 1:3631 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6404
Practice Address - Country:US
Practice Address - Phone:501-623-1998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD07891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist