Provider Demographics
NPI:1366045882
Name:MELANSON, SUZANNE L (RPH)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:L
Last Name:MELANSON
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 1:358 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3643
Mailing Address - Country:US
Mailing Address - Phone:860-678-8605
Mailing Address - Fax:860-676-1719
Practice Address - Street 1:358 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3643
Practice Address - Country:US
Practice Address - Phone:860-678-8605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist