Provider Demographics
NPI:1851401327
Name:YATES, MELISSA JO (PHARMD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JO
Last Name:YATES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:JO
Other - Last Name:PAMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1111 N LEE AVE STE 248
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2625
Mailing Address - Country:US
Mailing Address - Phone:405-766-6588
Mailing Address - Fax:888-491-5888
Practice Address - Street 1:57950 LEAVENWORTH ST
Practice Address - Street 2:22 MDSS/SGSAP
Practice Address - City:MCCONNELL AFB
Practice Address - State:KS
Practice Address - Zip Code:67221-3506
Practice Address - Country:US
Practice Address - Phone:316-759-5509
Practice Address - Fax:316-759-5038
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20378183500000X
PARP045741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist