Provider Demographics
NPI:1386277739
Name:LAFORTEZA, MELANIE (PHARMD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:LAFORTEZA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 ICON WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-8803
Mailing Address - Country:US
Mailing Address - Phone:707-227-6330
Mailing Address - Fax:
Practice Address - Street 1:2148 ICON WAY STE 100
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-8803
Practice Address - Country:US
Practice Address - Phone:707-227-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA590101835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric