Provider Demographics
NPI:1871920116
Name:MELERINE, RANDY
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:
Last Name:MELERINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3748 LOYOLA DRIVE
Mailing Address - Street 2:286
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-7700
Mailing Address - Country:US
Mailing Address - Phone:504-237-4464
Mailing Address - Fax:
Practice Address - Street 1:3748 LOYOLA DRIVE
Practice Address - Street 2:SUITE 287
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-7700
Practice Address - Country:US
Practice Address - Phone:504-237-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath