Provider Demographics
NPI:1912376922
Name:STRACENER, MELANIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:STRACENER
Suffix:
Gender:F
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:PO BOX 453
Mailing Address - Street 2:
Mailing Address - City:IOTA
Mailing Address - State:LA
Mailing Address - Zip Code:70543-0453
Mailing Address - Country:US
Mailing Address - Phone:337-779-2258
Mailing Address - Fax:
Practice Address - Street 1:4070 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2820
Practice Address - Country:US
Practice Address - Phone:337-478-5591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-20
Last Update Date:2015-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist