Provider Demographics
NPI:1013550888
Name:HARRIS, DANA O
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:O
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:H
Other - Last Name:PITTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46230 JENKINS RD 2
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-8267
Mailing Address - Country:US
Mailing Address - Phone:601-441-5877
Mailing Address - Fax:
Practice Address - Street 1:1001 HIGHWAY 98 BYP
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-3741
Practice Address - Country:US
Practice Address - Phone:601-731-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.017355183500000X
MSE-09725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPST.017355OtherSTATE ID
MSE-09725OtherSTATE ID