Provider Demographics
NPI:1982850046
Name:WILKINS, MELISSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WILKINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:VANDER ARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12699 N CROOKED WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-8113
Mailing Address - Country:US
Mailing Address - Phone:602-402-5721
Mailing Address - Fax:
Practice Address - Street 1:9220 N THORNYDALE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-5025
Practice Address - Country:US
Practice Address - Phone:520-579-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist