MEDICARE: HARRIS PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy
2	333600000X	Pharmacy	5953	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336279645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRIS PHARMACY INC

Provider Business Mailing Address
First Line	:	1224 FIRST STREET
Second Line	:
City	:	KENNETT
State	:	MO
Zip	:	63857-2526
Country	:	US
Telephone Number	:	573-888-6006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1224 FIRST STREET
Second Line	:
City	:	KENNETT
State	:	MO
Zip	:	63857-2526
Country	:	US
Telephone Number	:	573-888-6006
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DARREN KEITH HARRIS
Credential	:	R.PH.
Telephone Number	:	573-888-6006

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/12/2019

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Directions to “HARRIS PHARMACY INC ” Practice Location

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