Provider Demographics
NPI:1225618010
Name:MELTON, DUSTIN (RPH)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:MELTON
Suffix:
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 1:116 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-1735
Mailing Address - Country:US
Mailing Address - Phone:217-465-8455
Mailing Address - Fax:217-463-1967
Practice Address - Street 1:116 W COURT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-1735
Practice Address - Country:US
Practice Address - Phone:217-465-8455
Practice Address - Fax:217-463-1967
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist