Provider Demographics
NPI:1164860821
Name:TROTTA, MELANIE (RPH)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:TROTTA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4101
Mailing Address - Country:US
Mailing Address - Phone:801-266-1215
Mailing Address - Fax:801-266-3010
Practice Address - Street 1:4515 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4101
Practice Address - Country:US
Practice Address - Phone:801-266-1215
Practice Address - Fax:801-266-3010
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8093805-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist