Provider Demographics
NPI:1659670974
Name:HARBAUGH, RICKY DAVID (RPH)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:DAVID
Last Name:HARBAUGH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7239
Mailing Address - Country:US
Mailing Address - Phone:301-729-2037
Mailing Address - Fax:
Practice Address - Street 1:10601 NEW GEORGES CREEK RD SW
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-1453
Practice Address - Country:US
Practice Address - Phone:301-689-9961
Practice Address - Fax:301-689-6028
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist