Provider Demographics
NPI:1538841127
Name:NELSON, MELANIE JANE (CPHT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:JANE
Last Name:NELSON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 E 800 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4245
Mailing Address - Country:US
Mailing Address - Phone:801-714-4150
Mailing Address - Fax:801-714-4102
Practice Address - Street 1:870 E 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4245
Practice Address - Country:US
Practice Address - Phone:801-714-4150
Practice Address - Fax:801-714-4102
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13251288-1717183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician