Provider Demographics
NPI:1386917920
Name:WALTERS, MELISSA CARRIE (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:CARRIE
Last Name:WALTERS
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 1:1802 JIM REDMAN PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-6914
Mailing Address - Country:US
Mailing Address - Phone:813-752-6192
Mailing Address - Fax:
Practice Address - Street 1:1802 JIM REDMAN PKWY
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-6914
Practice Address - Country:US
Practice Address - Phone:813-752-6192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS40617OtherSTATE PHARMACIST LICENSE NUMBER