Healthcare Provider Details

I. General information

NPI: 1780816983
Provider Name (Legal Business Name): MELISSA WOODCOCK RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 WALKER RD
EDGEWOOD NM
87015-8786
US

IV. Provider business mailing address

5 WALKER RD
EDGEWOOD NM
87015-8786
US

V. Phone/Fax

Practice location:
  • Phone: 505-281-0950
  • Fax: 505-281-1668
Mailing address:
  • Phone: 505-281-0950
  • Fax: 505-281-1668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00005295
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: