Provider Demographics
NPI:1295002210
Name:HARRIS, KENEISHA MICHELLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KENEISHA
Middle Name:MICHELLE
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 1:113 PELICAN CV
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-1599
Mailing Address - Country:US
Mailing Address - Phone:757-369-3992
Mailing Address - Fax:757-968-5381
Practice Address - Street 1:14440 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-3719
Practice Address - Country:US
Practice Address - Phone:757-874-5084
Practice Address - Fax:757-875-0280
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist