Provider Demographics
NPI:1407062797
Name:HARRELL, DAVID GREGORY (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GREGORY
Last Name:HARRELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ZEAGLER DR
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3811
Mailing Address - Country:US
Mailing Address - Phone:386-328-4652
Mailing Address - Fax:386-312-0466
Practice Address - Street 1:610 ZEAGLER DR
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3811
Practice Address - Country:US
Practice Address - Phone:386-328-4652
Practice Address - Fax:386-312-0466
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0012166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist