MEDICARE: DR. MELISSA ROYBAL PHARMD

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	183500000X	Pharmacist	6600	NM

General Provider Information

NPI Number	:	1235508409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA ROYBAL PHARMD

Provider Business Mailing Address
First Line	:	111 CENTRAL PARK SQ
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-4020
Country	:	US
Telephone Number	:	505-661-9560
Fax Number	:	505-661-9599

Provider Business Practice Location Address
First Line	:	111 CENTRAL PARK SQ
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-4020
Country	:	US
Telephone Number	:	505-661-9560
Fax Number	:	505-661-9599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2015
Last Update Date	:	09/17/2015

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