Provider Demographics
NPI:1134457278
Name:HARRIS, DALE EDWARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:EDWARD
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77011-4632
Mailing Address - Country:US
Mailing Address - Phone:713-924-6963
Mailing Address - Fax:
Practice Address - Street 1:220 S WAYSIDE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-4632
Practice Address - Country:US
Practice Address - Phone:713-924-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist