Provider Demographics
NPI:1073650149
Name:HARNISH, JAMES WILSON
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILSON
Last Name:HARNISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7241 E PINNACLE PASS LOOP
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-3464
Mailing Address - Country:US
Mailing Address - Phone:928-759-2389
Mailing Address - Fax:
Practice Address - Street 1:1044 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1642
Practice Address - Country:US
Practice Address - Phone:928-443-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist