Provider Demographics
NPI:1053386920
Name:MCMELLON, STEVE (RPH)
Entity type:Individual
Prefix:MR
First Name:STEVE
Middle Name:
Last Name:MCMELLON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19001 GOFF FARM RD
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39562-9826
Mailing Address - Country:US
Mailing Address - Phone:228-588-2888
Mailing Address - Fax:228-588-2890
Practice Address - Street 1:7100H HIGHWAY 614
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39562-7395
Practice Address - Country:US
Practice Address - Phone:228-588-2888
Practice Address - Fax:228-588-2890
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE06838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSBR5954878OtherDEA