Provider Demographics
NPI:1285982736
Name:MELLISON, DONNA MARIE (PHARMACIST MANAGER)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:MELLISON
Suffix:
Gender:F
Credentials:PHARMACIST MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 N WENATCHEE AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1558
Mailing Address - Country:US
Mailing Address - Phone:509-664-5111
Mailing Address - Fax:
Practice Address - Street 1:1340 N WENATCHEE AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1558
Practice Address - Country:US
Practice Address - Phone:509-664-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00041310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00041310OtherWA BOARD OF HEALTH