Healthcare Provider Details

I. General information

NPI: 1770551277
Provider Name (Legal Business Name): MELANCON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 VETERANS DR
CARENCRO LA
70520-3619
US

IV. Provider business mailing address

730 VETERANS DR
CARENCRO LA
70520-3619
US

V. Phone/Fax

Practice location:
  • Phone: 337-896-8434
  • Fax: 337-896-4454
Mailing address:
  • Phone: 337-896-8434
  • Fax: 337-896-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5874
License Number StateLA

VIII. Authorized Official

Name: EDMOND MELANCON
Title or Position: PRESIDENT
Credential: PD
Phone: 337-896-8434