Provider Demographics
NPI:1922494699
Name:HARRIS-CRAIG, MELISSA DANETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DANETTE
Last Name:HARRIS-CRAIG
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 1:384 SPIRO RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-6305
Mailing Address - Country:US
Mailing Address - Phone:606-308-4998
Mailing Address - Fax:
Practice Address - Street 1:1040 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2307
Practice Address - Country:US
Practice Address - Phone:606-256-9207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist