Provider Demographics
NPI:1790237238
Name:HUBBARD, MELISSA LINDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LINDA
Last Name:HUBBARD
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 1:12484 BLACK HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4420
Mailing Address - Country:US
Mailing Address - Phone:719-337-0205
Mailing Address - Fax:
Practice Address - Street 1:12484 BLACK HILLS DR
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-4420
Practice Address - Country:US
Practice Address - Phone:719-337-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO215051835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist