Provider Demographics
NPI:1962619627
Name:BERRIMAN, MELINDA (RPH)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:
Last Name:BERRIMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 TRIMLEY CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3865
Mailing Address - Country:US
Mailing Address - Phone:702-433-5512
Mailing Address - Fax:702-435-8520
Practice Address - Street 1:2851 N GREEN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0402
Practice Address - Country:US
Practice Address - Phone:702-435-9850
Practice Address - Fax:702-435-8520
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV14595OtherPHARMACY LICENSE