Healthcare Provider Details

I. General information

NPI: 1902402522
Provider Name (Legal Business Name): HARRIS ADLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 ROUTE 70
MEDFORD NJ
08055-2378
US

IV. Provider business mailing address

1621 CROWN POINT LN
CHERRY HILL NJ
08003-2757
US

V. Phone/Fax

Practice location:
  • Phone: 609-654-7710
  • Fax:
Mailing address:
  • Phone: 215-498-6838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02601500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: