Provider Demographics
NPI:1386720431
Name:MELTON, LARRY H (RPH)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:H
Last Name:MELTON
Suffix:
Gender:M
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:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38603-0126
Mailing Address - Country:US
Mailing Address - Phone:662-224-8922
Mailing Address - Fax:662-224-9111
Practice Address - Street 1:15917 BOUNDARY DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603-0126
Practice Address - Country:US
Practice Address - Phone:662-224-8922
Practice Address - Fax:662-224-9111
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE6060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist