Provider Demographics
NPI:1376875187
Name:NORRIS, LARISSA (RPH)
Entity Type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:
Last Name:NORRIS
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 1:568-574 W 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2705
Mailing Address - Country:US
Mailing Address - Phone:212-865-3894
Mailing Address - Fax:212-865-2382
Practice Address - Street 1:568-574 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-2705
Practice Address - Country:US
Practice Address - Phone:212-865-3894
Practice Address - Fax:212-865-2382
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist