Provider Demographics
NPI:1497156723
Name:MELGAR, MARY RUBY (RPH)
Entity Type:Individual
Prefix:
First Name:MARY RUBY
Middle Name:
Last Name:MELGAR
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 1:2203 MANNING ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4380
Mailing Address - Country:US
Mailing Address - Phone:661-703-1007
Mailing Address - Fax:
Practice Address - Street 1:2203 MANNING ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4380
Practice Address - Country:US
Practice Address - Phone:661-703-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist