Provider Demographics
NPI:1689015851
Name:DIAZ, MELISSA ANDREA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANDREA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USA BLDG 300B RM B113
Mailing Address - Street 2:PO BOX 210300
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0300
Mailing Address - Country:US
Mailing Address - Phone:520-621-0279
Mailing Address - Fax:
Practice Address - Street 1:220 W 6TH STREET USA B113
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0300
Practice Address - Country:US
Practice Address - Phone:520-621-0279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist