Provider Demographics
NPI:1043685779
Name:HARRIS, ROBERT MCCANTS III (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MCCANTS
Last Name:HARRIS
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:MCCANTS
Other - Last Name:HARRIS
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:128 LOVVORN AVE
Mailing Address - Street 2:
Mailing Address - City:BOWDON
Mailing Address - State:GA
Mailing Address - Zip Code:30108-1141
Mailing Address - Country:US
Mailing Address - Phone:770-258-3310
Mailing Address - Fax:770-258-7474
Practice Address - Street 1:128 LOVVORN AVE
Practice Address - Street 2:
Practice Address - City:BOWDON
Practice Address - State:GA
Practice Address - Zip Code:30108-1141
Practice Address - Country:US
Practice Address - Phone:770-258-3310
Practice Address - Fax:770-258-7474
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist