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General NPI Number Information
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NPI Number | 1689172694
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Entity Type | Individual
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Provider Name | LAURA FITZGERALD MELTON
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Gender | Female
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 01/24/2018
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Provider Practice Location Address
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Address Line | 589 W MAIN ST
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City | COOKEVILLE
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State | TN
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Zip | 38506-5320
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Country | US
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Telephone | 931-537-3850
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Fax | 931-537-3846
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Provider Business Mailing Address
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Address Line | 589 W MAIN ST
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City | COOKEVILLE
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State | TN
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Zip | 38506-5320
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Country | US
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Telephone | 931-537-3850
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Fax | 931-537-3846
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 34381
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License Number State | TN
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