MEDICARE: DR. MELYNN DAWN ROBERTS PHARM D

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	AR 8875	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AR 8875	OTHER	AR	STATE LICENSE

General Provider Information

NPI Number	:	1801986138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELYNN DAWN ROBERTS PHARM D

Provider Business Mailing Address
First Line	:	UNIT 3215
Second Line	:
City	:	APO
State	:	AE
Zip	:	09094-3215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5060 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4124
Country	:	US
Telephone Number	:	719-593-1474
Fax Number	:

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	01/25/2022

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