Provider Demographics
NPI:1679663710
Name:WEBB, HARRY ROBERT (PD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:ROBERT
Last Name:WEBB
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975
Mailing Address - Country:US
Mailing Address - Phone:574-223-2216
Mailing Address - Fax:
Practice Address - Street 1:724 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-1506
Practice Address - Country:US
Practice Address - Phone:574-223-2216
Practice Address - Fax:574-223-3987
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015068A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26015068AOtherINDIANA PHARMACY LICENSE