Healthcare Provider Details

I. General information

NPI: 1982999389
Provider Name (Legal Business Name): MICHELLE HARBOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 FORTUNA CENTER PLZ T-2017
DUMFRIES VA
22025-1538
US

IV. Provider business mailing address

4310 FORTUNA CENTER PLZ T-2017
DUMFRIES VA
22025-1538
US

V. Phone/Fax

Practice location:
  • Phone: 703-586-6133
  • Fax: 703-586-6846
Mailing address:
  • Phone: 703-586-6133
  • Fax: 703-586-6846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202205805
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: