Provider Demographics
NPI:1225007008
Name:MELANCON, EDMOND III (RPH)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:
Last Name:MELANCON
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-3623
Mailing Address - Country:US
Mailing Address - Phone:337-896-8845
Mailing Address - Fax:
Practice Address - Street 1:206 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-3623
Practice Address - Country:US
Practice Address - Phone:337-896-8845
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist