Provider Demographics
NPI:1992082143
Name:PLACKE, MELISSA ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:PLACKE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11365 HARBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8149
Mailing Address - Country:US
Mailing Address - Phone:574-247-9327
Mailing Address - Fax:574-247-9327
Practice Address - Street 1:60101 BODNAR BLVD
Practice Address - Street 2:SUITE 200E
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-9328
Practice Address - Country:US
Practice Address - Phone:574-335-8525
Practice Address - Fax:574-335-0811
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019354A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist