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General NPI Number Information
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NPI Number | 1366060188
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Entity Type | Individual
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Provider Name | MARY B HARRIS
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Gender | Female
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 5440 NW 86TH ST
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City | JOHNSTON
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State | IA
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Zip | 50131-1737
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Country | US
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Telephone | 515-331-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 8009 GOODMAN DR
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City | URBANDALE
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State | IA
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Zip | 50322-7318
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Country | US
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Telephone | 515-276-0762
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Fax | 515-252-9997
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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 | 14968
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License Number State | IA
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