Provider Demographics
NPI:1669467510
Name:HARRIS, ROBERT D (RPH, BCPP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RPH, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9532
Mailing Address - Country:US
Mailing Address - Phone:607-277-0198
Mailing Address - Fax:
Practice Address - Street 1:555 E MARKET ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3223
Practice Address - Country:US
Practice Address - Phone:607-727-1501
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA172301835P1300X
NY040355-11835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric