Provider Demographics
NPI:1336868884
Name:NEMEDEZ, MELISSA CASANOVA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CASANOVA
Last Name:NEMEDEZ
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 1:5275 W 7TH ST APT G142
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2319
Mailing Address - Country:US
Mailing Address - Phone:775-544-5141
Mailing Address - Fax:
Practice Address - Street 1:2890 NORTHTOWNE LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-2178
Practice Address - Country:US
Practice Address - Phone:775-358-4238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV22617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty