Provider Demographics
NPI:1083944235
Name:STRIEBY, MELISSA A
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:STRIEBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 E CHANDLER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-6267
Mailing Address - Country:US
Mailing Address - Phone:480-283-0119
Mailing Address - Fax:480-283-2775
Practice Address - Street 1:1334 E CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-6267
Practice Address - Country:US
Practice Address - Phone:480-283-0119
Practice Address - Fax:480-283-2775
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS11177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist