Healthcare Provider Details

I. General information

NPI: 1982102463
Provider Name (Legal Business Name): MELMARK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17413 BELLFLOWER BLVD
BELLFLOWER CA
90706-6603
US

IV. Provider business mailing address

17413 BELLFLOWER BLVD
BELLFLOWER CA
90706-6603
US

V. Phone/Fax

Practice location:
  • Phone: 562-804-0101
  • Fax: 562-804-0099
Mailing address:
  • Phone: 562-804-0101
  • Fax: 562-804-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER F TAKLA
Title or Position: CEO/PIC
Credential: PHARM
Phone: 562-804-0101