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General NPI Number Information
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NPI Number | 1326751074
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Entity Type | Individual
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Provider Name | MARK JAMES HARRIS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/27/2022
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 1600 DIAMOND STREET PHARMACY DEPT
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City | ONAWA
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State | IA
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Zip | 51040
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Country | US
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Telephone | 712-423-9258
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Fax | 712-423-9157
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Provider Business Mailing Address
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Address Line | 40 KAY CT
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City | COUNCIL BLFS
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State | IA
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Zip | 51503-1638
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Country | US
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Telephone | 712-325-4505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19435
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License Number State | IA
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