Provider Demographics
NPI:1861756140
Name:MELVILLE, TANIA (RX TECH)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:MELVILLE
Suffix:
Gender:F
Credentials:RX TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SR 9
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-8525
Mailing Address - Country:US
Mailing Address - Phone:425-334-4028
Mailing Address - Fax:
Practice Address - Street 1:621 SR 9
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-8525
Practice Address - Country:US
Practice Address - Phone:425-334-4028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00042845183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician