Provider Demographics
NPI:1558751347
Name:HARRIS, BERNADETTE JILLIAN (PTCB)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:JILLIAN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PTCB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 ROUTE 22 W
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6509
Mailing Address - Country:US
Mailing Address - Phone:908-769-8193
Mailing Address - Fax:908-941-1701
Practice Address - Street 1:1515 ROUTE 22 W
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6509
Practice Address - Country:US
Practice Address - Phone:908-769-8193
Practice Address - Fax:908-941-1701
Is Sole Proprietor?:No
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ330101051151754183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician