Healthcare Provider Details

I. General information

NPI: 1962141135
Provider Name (Legal Business Name): MELISSA JEAN WHELCHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 JEFFERSON ST NE
ALBUQUERQUE NM
87109-4307
US

IV. Provider business mailing address

8183 S CIRCLE S RANCH PL
VAIL AZ
85641-8936
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-4601
  • Fax: 505-881-4647
Mailing address:
  • Phone: 505-980-0998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007144
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: