Provider Demographics
NPI:1700326188
Name:THORNTON, MELISSA (RPH)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:THORNTON
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 1:40 GRANDBAY CT
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2479
Mailing Address - Country:US
Mailing Address - Phone:504-402-9002
Mailing Address - Fax:
Practice Address - Street 1:708 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-1790
Practice Address - Country:US
Practice Address - Phone:985-839-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist