=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316088339
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT GEORGE HARRIS R. PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2007
-----------------------------------------------------
Last Update Date | 02/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 E POTTSVILLE ST # 10
-----------------------------------------------------
City | PINE GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17963-1100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-345-4422
-----------------------------------------------------
Fax | 570-345-8708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 124 WALNUT ST
-----------------------------------------------------
City | PINE GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17963-1614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-345-4700
-----------------------------------------------------
Fax | 570-345-8708
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP026637L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------