=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659680346
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA HARRIS D.PH.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2010
-----------------------------------------------------
Last Update Date | 09/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 890 OVERTON PLZ
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38570-1731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-823-2044
-----------------------------------------------------
Fax | 931-823-9276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 890 OVERTON PLZ
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38570-1731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-823-2044
-----------------------------------------------------
Fax | 931-823-9276
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 34583
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------