Provider Demographics
NPI:1114228103
Name:HARRIS, JOSEPH STEVEN (BSPHARM)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:STEVEN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 S BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4429
Mailing Address - Country:US
Mailing Address - Phone:225-644-3030
Mailing Address - Fax:225-647-2706
Practice Address - Street 1:1817 S BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4429
Practice Address - Country:US
Practice Address - Phone:225-644-3030
Practice Address - Fax:225-647-2706
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1896101Medicaid