Provider Demographics
NPI:1851156848
Name:MORAVEJI, MELIKA
Entity Type:Individual
Prefix:
First Name:MELIKA
Middle Name:
Last Name:MORAVEJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12166 METRIC BLVD APT 260
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-8604
Mailing Address - Country:US
Mailing Address - Phone:512-969-1112
Mailing Address - Fax:
Practice Address - Street 1:5145 FM 620 N
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-1815
Practice Address - Country:US
Practice Address - Phone:512-266-1392
Practice Address - Fax:512-266-4796
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist