Provider Demographics
NPI:1225338726
Name:MAZA, MELISSA PARKMAN (RPH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:PARKMAN
Last Name:MAZA
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 1:8145 SW BARBUR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2849
Mailing Address - Country:US
Mailing Address - Phone:503-452-6212
Mailing Address - Fax:503-452-6816
Practice Address - Street 1:8145 SW BARBUR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2849
Practice Address - Country:US
Practice Address - Phone:503-452-6212
Practice Address - Fax:503-452-6816
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12382183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist