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General NPI Number Information
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NPI Number | 1558961268
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Entity Type | Individual
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Provider Name | GERAD AARON HARSY RPH
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Gender | Male
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | WALMART PHARMCY 1450 EAST MAIN ST
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City | CARBONDALE
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State | IL
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Zip | 62901
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Country | US
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Telephone | 618-549-0709
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 N REED STATION RD
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City | CARBONDALE
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State | IL
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Zip | 62901-8155
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Country | US
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Telephone | 618-303-5825
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051286134
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License Number State | IL
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