Provider Demographics
NPI:1063732139
Name:HARRIS, MONTE L (RPH)
Entity type:Individual
Prefix:
First Name:MONTE
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 KETTNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2420
Mailing Address - Country:US
Mailing Address - Phone:619-231-7405
Mailing Address - Fax:619-237-8873
Practice Address - Street 1:1411 KETTNER BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2420
Practice Address - Country:US
Practice Address - Phone:619-231-7405
Practice Address - Fax:619-237-8873
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist