Provider Demographics
NPI:1083221790
Name:HARRISON, KRISTA (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2713
Mailing Address - Country:US
Mailing Address - Phone:304-366-6182
Mailing Address - Fax:304-363-6389
Practice Address - Street 1:300 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2713
Practice Address - Country:US
Practice Address - Phone:304-366-6182
Practice Address - Fax:304-363-6389
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist