Healthcare Provider Details

I. General information

NPI: 1336279645
Provider Name (Legal Business Name): HARRIS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 FIRST STREET
KENNETT MO
63857-2526
US

IV. Provider business mailing address

1224 FIRST STREET
KENNETT MO
63857-2526
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-6006
  • Fax:
Mailing address:
  • Phone: 573-888-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number5953
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DARREN KEITH HARRIS
Title or Position: OWNER
Credential: R.PH.
Phone: 573-888-6006