Provider Demographics
NPI:1962605519
Name:PERKINS, MELISSA CHERI (RPH)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:CHERI
Last Name:PERKINS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:CHERI
Other - Last Name:RAINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-0843
Mailing Address - Country:US
Mailing Address - Phone:505-356-6695
Mailing Address - Fax:505-356-5948
Practice Address - Street 1:208 W. DL INGRAM AVE
Practice Address - Street 2:27SOMDG
Practice Address - City:CANNON
Practice Address - State:NM
Practice Address - Zip Code:88103-5014
Practice Address - Country:US
Practice Address - Phone:575-784-4028
Practice Address - Fax:575-784-7495
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00005823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist