Provider Demographics
NPI:1073879771
Name:BANNISTER, HARRIETTE L (BS PHARMACY)
Entity Type:Individual
Prefix:MS
First Name:HARRIETTE
Middle Name:L
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 FRONT ST
Mailing Address - Street 2:UNIT 3002
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7095
Mailing Address - Country:US
Mailing Address - Phone:858-231-1270
Mailing Address - Fax:619-205-1905
Practice Address - Street 1:700 E NAPLES CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6821
Practice Address - Country:US
Practice Address - Phone:619-205-1123
Practice Address - Fax:619-205-1905
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist