Provider Demographics
NPI:1194363853
Name:HARRIS, ANTHONY TODD II (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:TODD
Last Name:HARRIS
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 COLONY PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6638
Mailing Address - Country:US
Mailing Address - Phone:601-953-6880
Mailing Address - Fax:
Practice Address - Street 1:1167 HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-4409
Practice Address - Country:US
Practice Address - Phone:601-664-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-15590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty