Provider Demographics
NPI:1952410409
Name:HARRIS, LETITIA M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LETITIA
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 LAKE LYNN DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-8330
Mailing Address - Country:US
Mailing Address - Phone:504-398-1318
Mailing Address - Fax:
Practice Address - Street 1:7968 ESSEN PARK
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-7439
Practice Address - Country:US
Practice Address - Phone:225-761-6700
Practice Address - Fax:225-761-6760
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11589OtherPHARMACY LICSENCE