Provider Demographics
NPI:1477857589
Name:MELTON, BAILEY (PHARM D)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:MELTON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15917 BOUNDARY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38603
Mailing Address - Country:US
Mailing Address - Phone:662-224-8922
Mailing Address - Fax:
Practice Address - Street 1:15917 BOUNDARY DRIVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603
Practice Address - Country:US
Practice Address - Phone:662-224-8922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS010796183500000X
ARPD11450183500000X
TN35515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS010796OtherPHARMACY LICENSE, MISSISSIPPI