Provider Demographics
NPI:1104106293
Name:MELTON, JONATHAN CLINT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CLINT
Last Name:MELTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 TERRAPIN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-6113
Mailing Address - Country:US
Mailing Address - Phone:931-261-6332
Mailing Address - Fax:
Practice Address - Street 1:166 TERRAPIN RIDGE RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-6113
Practice Address - Country:US
Practice Address - Phone:931-261-6332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist