Provider Demographics
NPI:1851596944
Name:LACOUR, MELINDA ANN (RPH0)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:ANN
Last Name:LACOUR
Suffix:
Gender:F
Credentials:RPH0
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 880710
Mailing Address - Street 2:
Mailing Address - City:PUKALANI
Mailing Address - State:HI
Mailing Address - Zip Code:96788-0710
Mailing Address - Country:US
Mailing Address - Phone:808-572-8399
Mailing Address - Fax:
Practice Address - Street 1:55 PUKALANI ST
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8544
Practice Address - Country:US
Practice Address - Phone:808-572-8266
Practice Address - Fax:808-572-0144
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist