Healthcare Provider Details

I. General information

NPI: 1043368095
Provider Name (Legal Business Name): MELVILLE PHARMACY AND GIFT SHOPPE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6637 HIGHWAY 10
WASHINGTON LA
70589
US

IV. Provider business mailing address

6637 HIGHWAY 10
WASHINGTON LA
70589
US

V. Phone/Fax

Practice location:
  • Phone: 337-623-9992
  • Fax: 337-623-9964
Mailing address:
  • Phone: 337-623-9992
  • Fax: 337-623-9964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY.002980-IR
License Number StateLA

VIII. Authorized Official

Name: TERRY MENGARELLI
Title or Position: OWNER
Credential: RPH
Phone: 337-623-9964