1508520347 NPI number — MRS. ALEXIS CHRISTIANNA MELINIOTIS PHARMD

Table of content: MRS. ALEXIS CHRISTIANNA MELINIOTIS PHARMD (NPI 1508520347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508520347 NPI number — MRS. ALEXIS CHRISTIANNA MELINIOTIS PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELINIOTIS
Provider First Name:
ALEXIS
Provider Middle Name:
CHRISTIANNA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARRIS
Provider Other First Name:
ALEXIS
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMACIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1508520347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1206 MECHEM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUIDOSO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88345-7206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-258-2456
Provider Business Mailing Address Fax Number:
575-258-2465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1206 MECHEM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUIDOSO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88345-7206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-258-2456
Provider Business Practice Location Address Fax Number:
575-258-2465
Provider Enumeration Date:
10/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RP00009590 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RP00009590 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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