Provider Demographics
NPI:1730320813
Name:PRICE, HARLEY R (RPH)
Entity Type:Individual
Prefix:
First Name:HARLEY
Middle Name:R
Last Name:PRICE
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 1:11255 MOUNTAIN VIEW AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3809
Mailing Address - Country:US
Mailing Address - Phone:909-558-3088
Mailing Address - Fax:909-558-3965
Practice Address - Street 1:11255 MOUNTAIN VIEW AVE STE A
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3809
Practice Address - Country:US
Practice Address - Phone:909-558-3088
Practice Address - Fax:909-558-3965
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist