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General NPI Number Information
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NPI Number | 1457475683
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Entity Type | Individual
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Provider Name | ROGER HARRISON PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 17619 HWY 58 N
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City | DECATUR
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State | TN
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Zip | 37322
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Country | US
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Telephone | 423-334-5223
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Fax | 423-334-9732
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Provider Business Mailing Address
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Address Line | PO BOX 5
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City | MADISONVILLE
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State | TN
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Zip | 37354-0005
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Country | US
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Telephone | 423-334-5223
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Fax | 423-334-9732
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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 | 5021
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License Number State | TN
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