Provider Demographics
NPI:1942319587
Name:HARRISON, MARY PENOT (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PENOT
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-2537
Mailing Address - Country:US
Mailing Address - Phone:985-307-0943
Mailing Address - Fax:
Practice Address - Street 1:12125 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-3000
Practice Address - Country:US
Practice Address - Phone:985-785-9054
Practice Address - Fax:985-785-8772
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist