Provider Demographics
NPI:1386951275
Name:HARNISCH, MARC ANTHONY (RPH)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:ANTHONY
Last Name:HARNISCH
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 1:3920 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2558
Mailing Address - Country:US
Mailing Address - Phone:520-323-2695
Mailing Address - Fax:520-323-0151
Practice Address - Street 1:3920 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2558
Practice Address - Country:US
Practice Address - Phone:520-323-2695
Practice Address - Fax:520-323-0151
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist