Healthcare Provider Details

I. General information

NPI: 1467755041
Provider Name (Legal Business Name): HARRY JOHRT OHRT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E VETERANS ST
TOMAH WI
54660-3105
US

IV. Provider business mailing address

547 SKILLMAN AVE E
SAINT PAUL MN
55117-2114
US

V. Phone/Fax

Practice location:
  • Phone: 800-252-7188
  • Fax:
Mailing address:
  • Phone: 651-774-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number115337
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: