Provider Demographics
NPI:1508520347
Name:MELINIOTIS, ALEXIS CHRISTIANNA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:CHRISTIANNA
Last Name:MELINIOTIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:ALEXIS
Other - Middle Name:C
Other - Last Name:FARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1206 MECHEM DR
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-7206
Mailing Address - Country:US
Mailing Address - Phone:575-258-2456
Mailing Address - Fax:575-258-2465
Practice Address - Street 1:1206 MECHEM DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7206
Practice Address - Country:US
Practice Address - Phone:575-258-2456
Practice Address - Fax:575-258-2465
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRP00009590Medicaid