Provider Demographics
NPI:1487253902
Name:MELKUS, BROOKE ANNE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANNE
Last Name:MELKUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 DURANT ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503-3411
Mailing Address - Country:US
Mailing Address - Phone:406-661-1413
Mailing Address - Fax:
Practice Address - Street 1:261 DURANT ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81503-3411
Practice Address - Country:US
Practice Address - Phone:406-661-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0023350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist