Healthcare Provider Details

I. General information

NPI: 1275442303
Provider Name (Legal Business Name): MELMARK RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 S MAIN ST STE C
SANTA ANA CA
92701-6605
US

IV. Provider business mailing address

809 S MAIN ST STE C
SANTA ANA CA
92701-6605
US

V. Phone/Fax

Practice location:
  • Phone: 714-844-3116
  • Fax: 714-844-3116
Mailing address:
  • Phone: 714-844-3116
  • Fax: 714-844-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PETER TAKLA
Title or Position: OWNER
Credential: RPH
Phone: 714-844-3116