Healthcare Provider Details

I. General information

NPI: 1952743783
Provider Name (Legal Business Name): MELISSA THOMPSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EXEMPLA CIR
LAFAYETTE CO
80026-3370
US

IV. Provider business mailing address

200 EXEMPLA CIR
LAFAYETTE CO
80026-3370
US

V. Phone/Fax

Practice location:
  • Phone: 303-689-6117
  • Fax: 303-689-6124
Mailing address:
  • Phone: 303-689-6117
  • Fax: 303-689-6124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number17944
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: