Provider Demographics
NPI:1023562766
Name:PHELPS 111, HARRY L (PHARMD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:L
Last Name:PHELPS 111
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1901
Mailing Address - Country:US
Mailing Address - Phone:518-848-1879
Mailing Address - Fax:
Practice Address - Street 1:21 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1901
Practice Address - Country:US
Practice Address - Phone:518-848-1879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist