Provider Demographics
NPI:1013339456
Name:JARDELEZA, MELISSA BICO (RPH)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:BICO
Last Name:JARDELEZA
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 1:2501 S AVENUE B
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7734
Mailing Address - Country:US
Mailing Address - Phone:928-317-6863
Mailing Address - Fax:928-317-6869
Practice Address - Street 1:2501 S AVENUE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7734
Practice Address - Country:US
Practice Address - Phone:928-317-6863
Practice Address - Fax:928-317-6869
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-18
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist