Provider Demographics
NPI:1629368980
Name:HARRELL, JOHN LOUIS JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LOUIS
Last Name:HARRELL
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:HARRELL
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2801 DOUBLE CHURCHES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2748
Mailing Address - Country:US
Mailing Address - Phone:706-321-1081
Mailing Address - Fax:706-321-1723
Practice Address - Street 1:2801 DOUBLE CHURCHES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2748
Practice Address - Country:US
Practice Address - Phone:706-321-1081
Practice Address - Fax:706-321-1723
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist