Provider Demographics
NPI:1104124270
Name:BOURNES, MARIEN MASSIEL (CPHT)
Entity type:Individual
Prefix:MS
First Name:MARIEN
Middle Name:MASSIEL
Last Name:BOURNES
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17511 AUTUMN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-1176
Mailing Address - Country:US
Mailing Address - Phone:832-495-5744
Mailing Address - Fax:
Practice Address - Street 1:17511 AUTUMN HILLS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-1176
Practice Address - Country:US
Practice Address - Phone:832-495-5744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX177302183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician