Provider Demographics
NPI:1275924052
Name:MELTON, ERICA NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:NICOLE
Last Name:MELTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 TRAILRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-4772
Mailing Address - Country:US
Mailing Address - Phone:270-705-4754
Mailing Address - Fax:
Practice Address - Street 1:315 W BROADWAY
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2231
Practice Address - Country:US
Practice Address - Phone:270-247-3345
Practice Address - Fax:270-247-1344
Is Sole Proprietor?:No
Enumeration Date:2015-02-14
Last Update Date:2015-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist