Provider Demographics
NPI:1326751074
Name:HARRIS, MARK JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JAMES
Last Name:HARRIS
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 1:40 KAY CT
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1638
Mailing Address - Country:US
Mailing Address - Phone:712-325-4505
Mailing Address - Fax:
Practice Address - Street 1:1600 DIAMOND STREET
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:ONAWA
Practice Address - State:IA
Practice Address - Zip Code:51040
Practice Address - Country:US
Practice Address - Phone:712-423-9258
Practice Address - Fax:712-423-9157
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist