Provider Demographics
NPI:1366099178
Name:STUTZ, MELISSA ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:STUTZ
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 1:45 GRAVOIS BLUFFS PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-4012
Mailing Address - Country:US
Mailing Address - Phone:636-343-5488
Mailing Address - Fax:
Practice Address - Street 1:45 GRAVOIS BLUFFS PLAZA DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-4012
Practice Address - Country:US
Practice Address - Phone:636-343-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180299971835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist