Provider Demographics
NPI:1336255017
Name:LANCON, MELISSA ANN (RPH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:LANCON
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 1:1876 LAKE LANDING DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-7781
Mailing Address - Country:US
Mailing Address - Phone:281-796-2310
Mailing Address - Fax:
Practice Address - Street 1:1150 DEVEREUX DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2043
Practice Address - Country:US
Practice Address - Phone:281-335-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist