=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093489684
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE A CHE-SAMA PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2021
-----------------------------------------------------
Last Update Date | 08/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11603 W COKER LOOP
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78216-3098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-494-1245
-----------------------------------------------------
Fax | 210-209-0289
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 919 RACELAND RD
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78245-3790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-219-9648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 68948
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------