Provider Demographics
NPI:1659710408
Name:TRUJILLO, MELITON ANDREW JR (RPH)
Entity Type:Individual
Prefix:
First Name:MELITON
Middle Name:ANDREW
Last Name:TRUJILLO
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 S ENSENADA ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5823
Mailing Address - Country:US
Mailing Address - Phone:303-617-8187
Mailing Address - Fax:
Practice Address - Street 1:4611 S ENSENADA ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5823
Practice Address - Country:US
Practice Address - Phone:303-617-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11819OtherCOLORADO STATE BOARD OF PHARMACY