Provider Demographics
NPI:1578930087
Name:MELTON, CHARLES (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MELTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9912 DUNBARTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1442
Mailing Address - Country:US
Mailing Address - Phone:803-259-3649
Mailing Address - Fax:803-259-7943
Practice Address - Street 1:9912 DUNBARTON BLVD
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1442
Practice Address - Country:US
Practice Address - Phone:803-259-3649
Practice Address - Fax:803-259-7943
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist