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General NPI Number Information
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NPI Number | 1043393093
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Entity Type | Organization
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Legal Business Name | PHILLIP W & PHYLLIS J MELTON
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 118 E EVANS
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City | APACHE
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State | OK
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Zip | 73006-9802
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Country | US
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Telephone | 580-588-3639
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Fax | 580-588-3638
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Provider Business Mailing Address
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Address Line | PO BOX 315
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City | APACHE
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State | OK
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Zip | 73006-0315
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Country | US
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Telephone | 580-588-3639
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHILIP MELTON
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Credential | RPH
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Telephone | 405-247-3081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 203327
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License Number State | OK
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