Provider Demographics
NPI:1265724496
Name:PROCTOR, MELANIE KAY (PHARMD)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:KAY
Last Name:PROCTOR
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 1:14301 MARTIN DR APT 518
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3019
Mailing Address - Country:US
Mailing Address - Phone:218-368-8942
Mailing Address - Fax:
Practice Address - Street 1:14301 MARTIN DR APT 518
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3019
Practice Address - Country:US
Practice Address - Phone:218-368-8942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118186183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist