Provider Demographics
NPI:1205122454
Name:HARLAN, WILLIAM B (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:B
Last Name:HARLAN
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 1:168 WOODLANDS GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7107
Mailing Address - Country:US
Mailing Address - Phone:601-919-2002
Mailing Address - Fax:601-919-2002
Practice Address - Street 1:168 WOODLANDS GLEN CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-7107
Practice Address - Country:US
Practice Address - Phone:601-919-2002
Practice Address - Fax:601-919-2002
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-05046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist