Provider Demographics
NPI:1164859211
Name:GOMEZ, MELENIE ANNE (PHARMD)
Entity type:Individual
Prefix:
First Name:MELENIE
Middle Name:ANNE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MELENIE
Other - Middle Name:ANNE
Other - Last Name:IZQUIERDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:15421 SW 81ST CIRCLE LN APT 28
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2604
Mailing Address - Country:US
Mailing Address - Phone:786-246-7344
Mailing Address - Fax:
Practice Address - Street 1:15421 SW 81ST CIRCLE LN APT 28
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2604
Practice Address - Country:US
Practice Address - Phone:786-246-7344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist