Provider Demographics
NPI:1124304902
Name:FLORENTINO, MELISSA MYLA (RPH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MYLA
Last Name:FLORENTINO
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 1:2536 STURROCK DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-8762
Mailing Address - Country:US
Mailing Address - Phone:702-270-0007
Mailing Address - Fax:
Practice Address - Street 1:9305 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-6837
Practice Address - Country:US
Practice Address - Phone:702-914-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV16524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist