Provider Demographics
NPI:1538536826
Name:HARRIS, YVONNE RAE (RPH)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:RAE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERMAN
Mailing Address - State:NM
Mailing Address - Zip Code:88232-9764
Mailing Address - Country:US
Mailing Address - Phone:575-910-3237
Mailing Address - Fax:
Practice Address - Street 1:1110 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-5635
Practice Address - Country:US
Practice Address - Phone:575-622-7039
Practice Address - Fax:575-622-7643
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5666183500000X
OK11272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist