Provider Demographics
NPI:1003048513
Name:HARVILLE, ROBERT MARK (DPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MARK
Last Name:HARVILLE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-9612
Mailing Address - Country:US
Mailing Address - Phone:731-783-5128
Mailing Address - Fax:
Practice Address - Street 1:19 HUGHES DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1510
Practice Address - Country:US
Practice Address - Phone:731-668-9072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist