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NPI Code Detail

MEDICARE: DERRICK LAMONT HARRIS PHARM.D.

MEDICARE: DERRICK LAMONT HARRIS PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist0202213474VA

General Provider Information

NPI Number : 1710669551
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRICK LAMONT HARRIS PHARM.D.
Provider Business Mailing Address
First Line : 15200 QUIET FOREST CT
Second Line :
City : SOUTH CHESTERFIELD
State : VA
Zip : 23834-5442
Country : US
Telephone Number : 804-715-2511
Fax Number :
Provider Business Practice Location Address
First Line : 6400 IRON BRIDGE RD
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23234-5204
Country : US
Telephone Number : 804-271-8361
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2023
Last Update Date : 08/02/2023

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