Healthcare Provider Details

I. General information

NPI: 1790276103
Provider Name (Legal Business Name): HARRIS APOTHECARIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 15TH AVE
FRANKLIN NE
68939-1509
US

IV. Provider business mailing address

317 N WEBSTER ST
RED CLOUD NE
68970-2549
US

V. Phone/Fax

Practice location:
  • Phone: 308-425-3004
  • Fax: 308-425-3005
Mailing address:
  • Phone: 402-746-3335
  • Fax: 402-746-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HEATHER HARRIS OCKINGA
Title or Position: OWNER
Credential:
Phone: 308-289-3441