MEDICARE: JULIANNE LISA HARRIS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26021169A	IN

General Provider Information

NPI Number	:	1114211513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANNE LISA HARRIS RPH

Provider Business Mailing Address
First Line	:	1102 S THOMAS RD
Second Line	:	T-2440
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1144
Country	:	US
Telephone Number	:	260-434-4581
Fax Number	:	260-434-4591

Provider Business Practice Location Address
First Line	:	1102 S THOMAS RD
Second Line	:	T-2440
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1144
Country	:	US
Telephone Number	:	260-434-4581
Fax Number	:	260-434-4591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2011
Last Update Date	:	06/02/2011

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