Provider Demographics
NPI:1063797942
Name:VINES, MELONY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MELONY
Middle Name:
Last Name:VINES
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 1:149 HART STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHEPPARD AIR FORCE BASE
Mailing Address - State:TX
Mailing Address - Zip Code:76311
Mailing Address - Country:US
Mailing Address - Phone:940-676-6310
Mailing Address - Fax:
Practice Address - Street 1:149 HART STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:SHEPPARD AIR FORCE BASE
Practice Address - State:TX
Practice Address - Zip Code:76311
Practice Address - Country:US
Practice Address - Phone:940-676-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist