Provider Demographics
NPI:1710584040
Name:HARBIN, MELISSA ANN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:HARBIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 TIMBER VIEW TER
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-6481
Mailing Address - Country:US
Mailing Address - Phone:217-779-2357
Mailing Address - Fax:217-221-9135
Practice Address - Street 1:1400 HARRISON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-6706
Practice Address - Country:US
Practice Address - Phone:217-222-2930
Practice Address - Fax:217-221-9135
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist