Provider Demographics
NPI:1407445885
Name:HARRIS, JANE SUSAN
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:SUSAN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6416 HIGHWAY 157
Mailing Address - Street 2:
Mailing Address - City:LEIGHTON
Mailing Address - State:AL
Mailing Address - Zip Code:35646-4319
Mailing Address - Country:US
Mailing Address - Phone:256-394-2700
Mailing Address - Fax:
Practice Address - Street 1:3220 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-3322
Practice Address - Country:US
Practice Address - Phone:256-389-0085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist