Healthcare Provider Details

I. General information

NPI: 1114400173
Provider Name (Legal Business Name): ELIJAH JOHN HARMON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 W 26TH ST
ERIE PA
16508-1803
US

IV. Provider business mailing address

537 MONTMARC BLVD
ERIE PA
16504-2684
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-4012
  • Fax:
Mailing address:
  • Phone: 814-790-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452668
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: