MEDICARE: DOUGLAS ALLEN HARRIS RPH

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
1	183500000X	Pharmacist	0202006176	VA

General Provider Information

NPI Number	:	1871861054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS ALLEN HARRIS RPH

Provider Business Mailing Address
First Line	:	15187 STONE HORSE CREEK RD
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-1517
Country	:	US
Telephone Number	:	804-749-8623
Fax Number	:

Provider Business Practice Location Address
First Line	:	16151 TRAINHAM RD
Second Line	:
City	:	BEAVERDAM
State	:	VA
Zip	:	23015-1301
Country	:	US
Telephone Number	:	804-449-6333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2011
Last Update Date	:	12/02/2011

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