Provider Demographics
NPI:1609465970
Name:MELENDEZ, OTTO II
Entity Type:Individual
Prefix:
First Name:OTTO
Middle Name:
Last Name:MELENDEZ
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10919 LOUETTA RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1710
Mailing Address - Country:US
Mailing Address - Phone:281-257-4655
Mailing Address - Fax:866-554-3509
Practice Address - Street 1:10919 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1710
Practice Address - Country:US
Practice Address - Phone:281-257-4655
Practice Address - Fax:866-554-3509
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186081183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician