Provider Demographics
NPI:1275124653
Name:STEVENS, MELISSA RICHARD (RPH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RICHARD
Last Name:STEVENS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-3198
Mailing Address - Country:US
Mailing Address - Phone:337-684-5401
Mailing Address - Fax:337-684-5402
Practice Address - Street 1:209 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-3115
Practice Address - Country:US
Practice Address - Phone:337-684-5401
Practice Address - Fax:337-684-5402
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist