Provider Demographics
NPI:1235437955
Name:HARRIS, CARRIE NICOLE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:NICOLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 GEORGE WASHINGTON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072-3566
Mailing Address - Country:US
Mailing Address - Phone:804-642-2115
Mailing Address - Fax:804-684-9524
Practice Address - Street 1:2460 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3566
Practice Address - Country:US
Practice Address - Phone:804-642-2115
Practice Address - Fax:804-684-9524
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist