Provider Demographics
NPI:1316371297
Name:HARVEY, MELISA M (RPH)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:M
Last Name:HARVEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MELISA
Other - Middle Name:B
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:232 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-3120
Mailing Address - Country:US
Mailing Address - Phone:817-406-4546
Mailing Address - Fax:817-406-4550
Practice Address - Street 1:232 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020
Practice Address - Country:US
Practice Address - Phone:817-406-4546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist