Provider Demographics
NPI:1588426753
Name:HARRIS, JISHAUN EMMANUEL (PHARM D, RPH)
Entity type:Individual
Prefix:DR
First Name:JISHAUN
Middle Name:EMMANUEL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:JISHAUN
Other - Middle Name:EMMANUEL
Other - Last Name:HARRIS JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D, RPH
Mailing Address - Street 1:102 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-1171
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-1171
Practice Address - Country:US
Practice Address - Phone:912-588-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist