Provider Demographics
NPI:1053569194
Name:PACHECO, MELANIE M (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:M
Last Name:PACHECO
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 1:1640 RIO RANCHO BLVD
Mailing Address - Street 2:KMART PHARMACY
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124
Mailing Address - Country:US
Mailing Address - Phone:505-892-6460
Mailing Address - Fax:
Practice Address - Street 1:1640 RIO RANCHO BLVD
Practice Address - Street 2:KMART PHARMACY
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124
Practice Address - Country:US
Practice Address - Phone:505-892-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist