Provider Demographics
NPI:1235436270
Name:HARRISON, CHAD PHILIP (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:PHILIP
Last Name:HARRISON
Suffix:
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 1:201 MARIGOLD LN
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-5903
Mailing Address - Country:US
Mailing Address - Phone:334-655-5766
Mailing Address - Fax:334-615-7247
Practice Address - Street 1:4030 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-6389
Practice Address - Country:US
Practice Address - Phone:334-792-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist