Provider Demographics
NPI:1124313028
Name:RASA, MELANIE NICOLE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:NICOLE
Last Name:RASA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MISS
Other - First Name:MELANIE
Other - Middle Name:NICOLE
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:2417 N HASKELL AVE
Mailing Address - Street 2:T-0875
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3707
Mailing Address - Country:US
Mailing Address - Phone:214-370-5558
Mailing Address - Fax:
Practice Address - Street 1:2417 N HASKELL AVE
Practice Address - Street 2:T-0875
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3707
Practice Address - Country:US
Practice Address - Phone:214-370-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist