Healthcare Provider Details

I. General information

NPI: 1912843657
Provider Name (Legal Business Name): MELISSA CRUZ PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSW CRUZ PEREZ

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WANDERING LN
HARVEST AL
35749-8266
US

IV. Provider business mailing address

105 WANDERING LN
HARVEST AL
35749-8266
US

V. Phone/Fax

Practice location:
  • Phone: 256-919-1203
  • Fax:
Mailing address:
  • Phone: 256-919-1203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License NumberT71895
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: