Provider Demographics
NPI:1104965797
Name:HARMISON, JOSEPH H
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:H
Last Name:HARMISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 152643
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-8643
Mailing Address - Country:US
Mailing Address - Phone:972-647-2721
Mailing Address - Fax:
Practice Address - Street 1:2701 OSLER DR STE 1
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-8351
Practice Address - Country:US
Practice Address - Phone:972-647-2721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19030183500000X
OK8107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19030OtherLICENSE NUMBER