Provider Demographics
NPI:1982999389
Name:HARBOUR, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HARBOUR
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 1:4310 FORTUNA CENTER PLZ
Mailing Address - Street 2:T-2017
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1538
Mailing Address - Country:US
Mailing Address - Phone:703-586-6133
Mailing Address - Fax:703-586-6846
Practice Address - Street 1:4310 FORTUNA CENTER PLZ
Practice Address - Street 2:T-2017
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-1538
Practice Address - Country:US
Practice Address - Phone:703-586-6133
Practice Address - Fax:703-586-6846
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist