Provider Demographics
NPI:1447436498
Name:HARALDSEN, JAMES WILLIAM
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:HARALDSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1606
Mailing Address - Country:US
Mailing Address - Phone:845-876-1402
Mailing Address - Fax:845-876-1410
Practice Address - Street 1:48 E MARKET ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1606
Practice Address - Country:US
Practice Address - Phone:845-876-1402
Practice Address - Fax:845-876-1410
Is Sole Proprietor?:No
Enumeration Date:2008-01-20
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist