Provider Demographics
NPI:1386976884
Name:HARRISON, PETER M (RPH)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:HARRISON
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 1:142 WINDMILL PT EXT
Mailing Address - Street 2:
Mailing Address - City:ALBURGH
Mailing Address - State:VT
Mailing Address - Zip Code:05440-9743
Mailing Address - Country:US
Mailing Address - Phone:802-796-3486
Mailing Address - Fax:
Practice Address - Street 1:866 STATE ROUTE 11
Practice Address - Street 2:
Practice Address - City:CHAMPLAIN
Practice Address - State:NY
Practice Address - Zip Code:12919
Practice Address - Country:US
Practice Address - Phone:518-298-5343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist