Provider Demographics
NPI:1104199322
Name:HARMAN, FREDERICK JON (RPH)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:JON
Last Name:HARMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 SANTIAM SPRINGS CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-9544
Mailing Address - Country:US
Mailing Address - Phone:503-508-2468
Mailing Address - Fax:
Practice Address - Street 1:2155 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1228
Practice Address - Country:US
Practice Address - Phone:503-588-8173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-18
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR8694OtherSTATE PHARMACIST LICENSE