Provider Demographics
NPI:1114211513
Name:HARRIS, JULIANNE LISA (RPH)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:LISA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 S THOMAS RD
Mailing Address - Street 2:T-2440
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1144
Mailing Address - Country:US
Mailing Address - Phone:260-434-4581
Mailing Address - Fax:260-434-4591
Practice Address - Street 1:1102 S THOMAS RD
Practice Address - Street 2:T-2440
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1144
Practice Address - Country:US
Practice Address - Phone:260-434-4581
Practice Address - Fax:260-434-4591
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021169A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist