Provider Demographics
NPI:1336561851
Name:HARRIS, RICHARD CARL (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CARL
Last Name:HARRIS
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 1:805 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-1229
Mailing Address - Country:US
Mailing Address - Phone:608-692-3256
Mailing Address - Fax:
Practice Address - Street 1:801 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:WI
Practice Address - Zip Code:53555-1279
Practice Address - Country:US
Practice Address - Phone:608-592-3256
Practice Address - Fax:608-592-7406
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist