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General NPI Number Information
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NPI Number | 1770551277
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Entity Type | Organization
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Legal Business Name | MELANCON PHARMACY INC
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 730 VETERANS DR
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City | CARENCRO
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State | LA
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Zip | 70520-3619
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Country | US
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Telephone | 337-896-8434
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Fax | 337-896-4454
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Provider Business Mailing Address
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Address Line | 730 VETERANS DR
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City | CARENCRO
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State | LA
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Zip | 70520-3619
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Country | US
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Telephone | 337-896-8434
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Fax | 337-896-4654
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDMOND MELANCON
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Credential | PD
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Telephone | 337-896-8434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5874
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License Number State | LA
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