Healthcare Provider Details

I. General information

NPI: 1851596944
Provider Name (Legal Business Name): MELINDA ANN LACOUR RPH.0
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PUKALANI ST
MAKAWAO HI
96768-8544
US

IV. Provider business mailing address

PO BOX 880710
PUKALANI HI
96788-0710
US

V. Phone/Fax

Practice location:
  • Phone: 808-572-8266
  • Fax: 808-572-0144
Mailing address:
  • Phone: 808-572-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1666
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: