Provider Demographics
NPI:1316350978
Name:MELSON, ANN MARIE (MS, PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE
Last Name:MELSON
Suffix:
Gender:F
Credentials:MS, PHARMD
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:GOODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PHARMD
Mailing Address - Street 1:2114 11TH ST SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4512
Mailing Address - Country:US
Mailing Address - Phone:256-565-7267
Mailing Address - Fax:
Practice Address - Street 1:6051 U S HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7201
Practice Address - Country:US
Practice Address - Phone:601-288-4138
Practice Address - Fax:601-288-4163
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL17509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist