Healthcare Provider Details

I. General information

NPI: 1528367844
Provider Name (Legal Business Name): MARY LOU HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 E ATLANTIC ST
SOUTH HILL VA
23970-3423
US

IV. Provider business mailing address

807 E ATLANTIC ST
SOUTH HILL VA
23970-3423
US

V. Phone/Fax

Practice location:
  • Phone: 434-447-3117
  • Fax: 434-447-2352
Mailing address:
  • Phone: 434-447-3117
  • Fax: 434-447-2352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202007151
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP035652R
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: