Provider Demographics
NPI:1154956332
Name:VANDERMAUSE, MELISSA CATHERINE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:CATHERINE
Last Name:VANDERMAUSE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20250 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6869
Mailing Address - Country:US
Mailing Address - Phone:952-469-8404
Mailing Address - Fax:
Practice Address - Street 1:20250 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6869
Practice Address - Country:US
Practice Address - Phone:952-469-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-08
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125487183500000X
WI19991-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist