Provider Demographics
NPI:1821705773
Name:MELANCON, ELIZABETH JEANNE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JEANNE
Last Name:MELANCON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:102 BUCKLERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-5975
Mailing Address - Country:US
Mailing Address - Phone:337-303-3471
Mailing Address - Fax:
Practice Address - Street 1:208 E SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-4009
Practice Address - Country:US
Practice Address - Phone:337-896-3241
Practice Address - Fax:337-896-6741
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACPT.014210183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician