Provider Demographics
NPI:1588777916
Name:HORN, HARRY ROSSITER (RPH)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:ROSSITER
Last Name:HORN
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 1:4675 SIGNATURE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2364
Mailing Address - Country:US
Mailing Address - Phone:608-827-5730
Mailing Address - Fax:608-827-5730
Practice Address - Street 1:4675 SIGNATURE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2364
Practice Address - Country:US
Practice Address - Phone:608-827-5730
Practice Address - Fax:608-827-5730
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA13551-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist