Provider Demographics
NPI:1922316330
Name:SMITH, MELISSA SUZANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SUZANNE
Last Name:SMITH
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 1:202 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:SPRINGHILL
Mailing Address - State:LA
Mailing Address - Zip Code:71075-2726
Mailing Address - Country:US
Mailing Address - Phone:318-539-5601
Mailing Address - Fax:318-539-9230
Practice Address - Street 1:801 S ARKANSAS ST STE 2
Practice Address - Street 2:
Practice Address - City:SPRINGHILL
Practice Address - State:LA
Practice Address - Zip Code:71075-3723
Practice Address - Country:US
Practice Address - Phone:318-539-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist