Provider Demographics
NPI:1285068817
Name:CLARK, MELISSA ANNE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15700 E BRIARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1558
Mailing Address - Country:US
Mailing Address - Phone:720-214-6000
Mailing Address - Fax:
Practice Address - Street 1:15700 E BRIARWOOD CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-1558
Practice Address - Country:US
Practice Address - Phone:720-214-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist