Provider Demographics
NPI:1780816983
Name:WOODCOCK, MELISSA (RPH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WOODCOCK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-8786
Mailing Address - Country:US
Mailing Address - Phone:505-281-0950
Mailing Address - Fax:505-281-1668
Practice Address - Street 1:5 WALKER RD
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-8786
Practice Address - Country:US
Practice Address - Phone:505-281-0950
Practice Address - Fax:505-281-1668
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00005295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist