Provider Demographics
NPI:1568572212
Name:ALLEN, MELODY W (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:W
Last Name:ALLEN
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 1:2426 MALMAISON STREET
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701
Mailing Address - Country:US
Mailing Address - Phone:662-332-5700
Mailing Address - Fax:662-335-4703
Practice Address - Street 1:1467 HWY 1 SOUTH
Practice Address - Street 2:SANDERS PHARMACY
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701
Practice Address - Country:US
Practice Address - Phone:662-335-6060
Practice Address - Fax:662-335-8128
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE8029183500000X
ARPD09810183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist