Provider Demographics
NPI:1184907321
Name:HURST, MELISSA ANNE (RPH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:HURST
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 N IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-3566
Mailing Address - Country:US
Mailing Address - Phone:574-234-5046
Mailing Address - Fax:
Practice Address - Street 1:1351 N IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3566
Practice Address - Country:US
Practice Address - Phone:574-234-5046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018851A183500000X
MI5302036658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist