Provider Demographics
NPI:1073869483
Name:HARRIS, ANDREA WHITNEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:WHITNEY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 TANTALLON LN
Mailing Address - Street 2:#107
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2887
Mailing Address - Country:US
Mailing Address - Phone:662-316-1808
Mailing Address - Fax:
Practice Address - Street 1:1675 N GERMANTOWN PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5962
Practice Address - Country:US
Practice Address - Phone:901-624-9637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000036284183500000X
MSE-11894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist