MEDICARE: MELROSE PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336S0011X	Specialty Pharmacy
3	3336C0004X	Compounding Pharmacy
4	333600000X	Pharmacy
5	3336C0003X	Community/Retail Pharmacy	Y04279	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1991935	OTHER		PK

General Provider Information

NPI Number	:	1073628095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELROSE PHARMACY LLC

Provider Business Mailing Address
First Line	:	706 W MONTECITO AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2814
Country	:	US
Telephone Number	:	602-277-4714
Fax Number	:	602-264-1469

Provider Business Practice Location Address
First Line	:	706 W MONTECITO AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2814
Country	:	US
Telephone Number	:	602-277-4714
Fax Number	:	602-264-1469

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TERESA STICKLER
Credential	:
Telephone Number	:	602-277-4714

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	02/20/2017

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Directions to “MELROSE PHARMACY LLC ” Practice Location

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