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NPI Code Detail

MEDICARE: MR. ROBERT D. HARRIS R.PH., BCPP

MEDICARE: MR. ROBERT D. HARRIS R.PH., BCPP
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
11835P1300XPsychiatric Pharmacist17230MA
21835P1300XPsychiatric Pharmacist040355-1NY

General Provider Information

NPI Number : 1669467510
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT D. HARRIS R.PH., BCPP
Provider Business Mailing Address
First Line : 101 GROVE RD
Second Line :
City : ITHACA
State : NY
Zip : 14850-9532
Country : US
Telephone Number : 607-277-0198
Fax Number :
Provider Business Practice Location Address
First Line : 555 E MARKET ST
Second Line :
City : ELMIRA
State : NY
Zip : 14901-3223
Country : US
Telephone Number : 607-727-1501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2005
Last Update Date : 07/08/2007

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