Healthcare Provider Details

I. General information

NPI: 1689301962
Provider Name (Legal Business Name): EDDIE HARRIS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 SUPERIOR AVE
CLEVELAND OH
44103-1344
US

IV. Provider business mailing address

5411 SUPERIOR AVE
CLEVELAND OH
44103-1344
US

V. Phone/Fax

Practice location:
  • Phone: 216-431-5643
  • Fax: 216-431-5643
Mailing address:
  • Phone: 216-431-5643
  • Fax: 216-431-4482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: