=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174538797
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARRISON HEALTHCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 06/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2328 N CHARLES ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21218-5127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-467-0634
-----------------------------------------------------
Fax | 410-467-0636
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2328 N CHARLES ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21218-5127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HARRISON EGBIREMOLEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-467-0634
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | PW0268
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------