Provider Demographics
NPI:1689096224
Name:MELTON, SANDRA (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MELTON
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 1:1028 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4904
Mailing Address - Country:US
Mailing Address - Phone:540-886-4208
Mailing Address - Fax:540-886-6205
Practice Address - Street 1:1028 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4904
Practice Address - Country:US
Practice Address - Phone:540-886-4208
Practice Address - Fax:540-886-6205
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist