Provider Demographics
NPI:1316518822
Name:HUMBLE, MELISSA LINN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LINN
Last Name:HUMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2489 E LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-9712
Mailing Address - Country:US
Mailing Address - Phone:517-332-0888
Mailing Address - Fax:517-351-1336
Practice Address - Street 1:2489 E LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-9712
Practice Address - Country:US
Practice Address - Phone:517-332-0888
Practice Address - Fax:517-351-1336
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5353003144183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician