Provider Demographics
NPI:1285901165
Name:ENG, MELISSA II
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ENG
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 E 9TH AVE
Mailing Address - Street 2:#100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3901
Mailing Address - Country:US
Mailing Address - Phone:303-333-4678
Mailing Address - Fax:303-333-0896
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:#100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3901
Practice Address - Country:US
Practice Address - Phone:303-333-4678
Practice Address - Fax:303-333-0896
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist