Provider Demographics
NPI:1730465071
Name:RODRIGUEZ, MELISSA FORBES (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:FORBES
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:FORBES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7239 STEINMEIER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2574
Mailing Address - Country:US
Mailing Address - Phone:317-925-3788
Mailing Address - Fax:317-926-1898
Practice Address - Street 1:3003 KESSLER BLVD NORTH DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1990
Practice Address - Country:US
Practice Address - Phone:317-925-3788
Practice Address - Fax:317-926-1898
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019226A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist