Provider Demographics
NPI:1588782759
Name:HARRICA, ELAINE IRENE (RPH)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:IRENE
Last Name:HARRICA
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 1:47 HAMMOND STREET
Mailing Address - Street 2:
Mailing Address - City:DANNEMORA
Mailing Address - State:NY
Mailing Address - Zip Code:12929-0732
Mailing Address - Country:US
Mailing Address - Phone:518-492-7160
Mailing Address - Fax:
Practice Address - Street 1:19 CENTRE DR
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6553
Practice Address - Country:US
Practice Address - Phone:518-562-3565
Practice Address - Fax:518-562-3859
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist