Provider Demographics
NPI:1730566274
Name:MONTGOMERY, MELODY MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MELODY
Middle Name:MARIE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MELODY
Other - Middle Name:MARIE
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:35629 HIGHWAY 72
Mailing Address - Street 2:PO BOX 774
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-7217
Mailing Address - Country:US
Mailing Address - Phone:573-729-5917
Mailing Address - Fax:573-729-8002
Practice Address - Street 1:35629 HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-7217
Practice Address - Country:US
Practice Address - Phone:573-729-5917
Practice Address - Fax:573-729-8002
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008004322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist