Provider Demographics
NPI:1871969915
Name:DEMORRIS, MELISSA (RPH)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:DEMORRIS
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 1:5005 N PIEDRAS ST
Mailing Address - Street 2:WBAMC OUTPATIENT PHARMACY
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920
Mailing Address - Country:US
Mailing Address - Phone:915-742-2469
Mailing Address - Fax:
Practice Address - Street 1:5005 N PIEDRAS ST
Practice Address - Street 2:WBAMC OUTPATIENT PHARMACY
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920
Practice Address - Country:US
Practice Address - Phone:915-742-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36244OtherBOARD OF PHARMACY