Healthcare Provider Details

I. General information

NPI: 1659623692
Provider Name (Legal Business Name): WESLEY N HARBISON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2012
Last Update Date: 10/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W WILLOW ST
LAFAYETTE LA
70501-2841
US

IV. Provider business mailing address

905 GREENBRIAR RD
LAFAYETTE LA
70503-3526
US

V. Phone/Fax

Practice location:
  • Phone: 337-572-9053
  • Fax:
Mailing address:
  • Phone: 337-993-0081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number015349
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: