Provider Demographics
NPI:1982290037
Name:BORDEN-HARRIS, ROSALYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:
Last Name:BORDEN-HARRIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 JUMPERS TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4805
Mailing Address - Country:US
Mailing Address - Phone:850-251-2205
Mailing Address - Fax:
Practice Address - Street 1:560 AMSTERDAM AVE NE STE E
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-3479
Practice Address - Country:US
Practice Address - Phone:404-892-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist