Provider Demographics
NPI:1316239742
Name:DALTON, MELODY STARR (PHARMD)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:STARR
Last Name:DALTON
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 1:3045 VICTORIAN PL
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9486
Mailing Address - Country:US
Mailing Address - Phone:304-932-9262
Mailing Address - Fax:
Practice Address - Street 1:6401 US ROUTE 60 E
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1200
Practice Address - Country:US
Practice Address - Phone:304-736-2837
Practice Address - Fax:304-733-1203
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist