Provider Demographics
NPI:1780288647
Name:GASTON, MELISSA (RPH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GASTON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:DEHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:470 ADRIATIC PKWY APT 2236
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-5914
Mailing Address - Country:US
Mailing Address - Phone:432-230-1632
Mailing Address - Fax:
Practice Address - Street 1:2210 N FM 1417
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-3103
Practice Address - Country:US
Practice Address - Phone:903-209-4907
Practice Address - Fax:903-209-4906
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist