Provider Demographics
NPI:1114088788
Name:WHEAT, HARRY HOUSTON III
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:HOUSTON
Last Name:WHEAT
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39355-2638
Mailing Address - Country:US
Mailing Address - Phone:601-776-3552
Mailing Address - Fax:
Practice Address - Street 1:721 FRONT STREET EXT
Practice Address - Street 2:SUITE 732 ACME PLAZA
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4500
Practice Address - Country:US
Practice Address - Phone:601-482-4003
Practice Address - Fax:601-482-3948
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06727183500000X
AL7575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist