Provider Demographics
NPI:1275845018
Name:HARRISON, MYRA AGNES (RPH, CIP)
Entity Type:Individual
Prefix:MS
First Name:MYRA
Middle Name:AGNES
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RPH, CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8015 LIMONETE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509
Mailing Address - Country:US
Mailing Address - Phone:951-361-0263
Mailing Address - Fax:951-361-9413
Practice Address - Street 1:8015 LIMONETE
Practice Address - Street 2:RITE AID
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509
Practice Address - Country:US
Practice Address - Phone:951-361-0263
Practice Address - Fax:951-361-9413
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA041515183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist