Provider Demographics
NPI:1386829877
Name:HARRIS, REGINAL D (PHARMD, RPH, CPH)
Entity Type:Individual
Prefix:DR
First Name:REGINAL
Middle Name:D
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHARMD, RPH, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:INFOSOURCE COMMUNICATIONS, LLC
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-0382
Mailing Address - Country:US
Mailing Address - Phone:210-896-1666
Mailing Address - Fax:
Practice Address - Street 1:12702 TOEPPERWEIN RD
Practice Address - Street 2:SUITE 207
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3278
Practice Address - Country:US
Practice Address - Phone:210-896-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38076183500000X, 1835G0303X, 1835P0018X, 1835P1200X
FLPS 32996183500000X
FLPU 57371835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist