Active NPI
Melissa Ann Ernzen, PHARM.D.
- Pharmacist
- Dubuque, IA
National Provider Identifier
1457441446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19191
- Practice address
- 1920 Elm St
Dubuque, IA 52001-3641 - Phone
- (563) 583-7379
- Fax
- (563) 583-8846
- NPI assigned
- Oct 13, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19191 | IA | Primary |
Addresses
Primary practice location
1920 Elm St
Dubuque, IA 52001-3641
Mailing address
302 Countryside Dr
Epworth, IA 52045-9523
Phone (563) 876-5599
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005058 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19191 | IA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Family Pharmacy | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1457441446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "302 COUNTRYSIDE DR",
"city": "EPWORTH",
"state": "IA",
"postal_code": "520459523",
"telephone_number": "563-876-5599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1920 ELM ST",
"city": "DUBUQUE",
"state": "IA",
"postal_code": "520013641",
"telephone_number": "563-583-7379",
"fax_number": "563-583-8846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ERNZEN",
"first_name": "MELISSA",
"middle_name": "ANN",
"credential": "PHARM.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-13",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "19191",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0005058",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dubuque, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.