Provider Demographics
NPI:1053884056
Name:MUSGROVE, MELVIN B (RPH)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:B
Last Name:MUSGROVE
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 1:607 W MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4608
Mailing Address - Country:US
Mailing Address - Phone:817-688-7723
Mailing Address - Fax:817-314-7227
Practice Address - Street 1:607 W MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4608
Practice Address - Country:US
Practice Address - Phone:817-688-7723
Practice Address - Fax:817-314-7227
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist