Healthcare Provider Details

I. General information

NPI: 1447309414
Provider Name (Legal Business Name): HARRISON DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25372 HIGHWAY 195
DOUBLE SPRINGS AL
35553
US

IV. Provider business mailing address

PO BOX 505 25372 HIGHWAY 195
DOUBLE SPRINGS AL
35553-0505
US

V. Phone/Fax

Practice location:
  • Phone: 205-489-8806
  • Fax: 205-489-8422
Mailing address:
  • Phone: 205-489-8806
  • Fax: 205-489-8422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number105153
License Number StateAL

VIII. Authorized Official

Name: MR. REX EUGENE HARRISON
Title or Position: OWNER
Credential: RPH
Phone: 205-489-8806