Provider Demographics
NPI:1780892034
Name:SHAKE, MELISSA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:SHAKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6192 WINSTON FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6869
Mailing Address - Country:US
Mailing Address - Phone:702-340-9993
Mailing Address - Fax:
Practice Address - Street 1:6865 W TROPICANA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4383
Practice Address - Country:US
Practice Address - Phone:702-871-1623
Practice Address - Fax:702-871-3314
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist