Provider Demographics
NPI:1972594653
Name:HARMON, ANDREW W (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:W
Last Name:HARMON
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:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-0843
Mailing Address - Country:US
Mailing Address - Phone:505-356-6695
Mailing Address - Fax:505-356-5948
Practice Address - Street 1:1515 W FIR ST
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-5703
Practice Address - Country:US
Practice Address - Phone:505-356-6695
Practice Address - Fax:505-356-5948
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006675183500000X
NMPC00000116183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered183700000XPharmacy Service ProvidersPharmacy Technician