Provider Demographics
NPI:1720326770
Name:HARRIS, JOHN ERIC (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ERIC
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 1:308 WORMLEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-4213
Mailing Address - Country:US
Mailing Address - Phone:757-746-7567
Mailing Address - Fax:
Practice Address - Street 1:308 WORMLEY CREEK DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-4213
Practice Address - Country:US
Practice Address - Phone:757-746-7567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist