Provider Demographics
NPI:1295330603
Name:HARLAN, CHELSEA
Entity type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:
Last Name:HARLAN
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 1:171 HINCHMAN RD
Mailing Address - Street 2:
Mailing Address - City:BARODA
Mailing Address - State:MI
Mailing Address - Zip Code:49101-9717
Mailing Address - Country:US
Mailing Address - Phone:269-326-0236
Mailing Address - Fax:
Practice Address - Street 1:2051 S BEND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-5686
Practice Address - Country:US
Practice Address - Phone:574-273-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27027722A183500000X
MI5302046382183500000X
IN26027722A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist