Healthcare Provider Details

I. General information

NPI: 1841226339
Provider Name (Legal Business Name): HARRIS BROTHERS APOTHECARIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MAIN ST
WINTERVILLE GA
30683-0158
US

IV. Provider business mailing address

PO BOX 158
WINTERVILLE GA
30683-0158
US

V. Phone/Fax

Practice location:
  • Phone: 706-742-8500
  • Fax: 706-742-8927
Mailing address:
  • Phone: 706-742-8500
  • Fax: 706-742-8927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4085
License Number StateGA

VIII. Authorized Official

Name: MR. RONALD THOMAS HARRIS
Title or Position: OWNER
Credential: RPH
Phone: 706-742-8500