Provider Demographics
NPI:1992562821
Name:HARNER, MELISSA MICHELLE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MICHELLE
Last Name:HARNER
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 1:13109 MARBLE FALLS CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729-7544
Mailing Address - Country:US
Mailing Address - Phone:512-922-2608
Mailing Address - Fax:
Practice Address - Street 1:13109 MARBLE FALLS CV
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729-7544
Practice Address - Country:US
Practice Address - Phone:512-922-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174173183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No183700000XPharmacy Service ProvidersPharmacy Technician