Healthcare Provider Details

I. General information

NPI: 1235508409
Provider Name (Legal Business Name): MELISSA ROYBAL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CENTRAL PARK SQ
LOS ALAMOS NM
87544-4020
US

IV. Provider business mailing address

111 CENTRAL PARK SQ
LOS ALAMOS NM
87544-4020
US

V. Phone/Fax

Practice location:
  • Phone: 505-661-9560
  • Fax: 505-661-9599
Mailing address:
  • Phone: 505-661-9560
  • Fax: 505-661-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6600
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: