Provider Demographics
NPI:1780026062
Name:EERNISSE, HARVEY JOEL (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:JOEL
Last Name:EERNISSE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-7330
Mailing Address - Country:US
Mailing Address - Phone:515-570-3847
Mailing Address - Fax:
Practice Address - Street 1:2012 N 26TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-7330
Practice Address - Country:US
Practice Address - Phone:515-570-3847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist