Provider Demographics
NPI:1407636178
Name:HARRIS, KRISTEN C (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4412
Mailing Address - Country:US
Mailing Address - Phone:267-970-1520
Mailing Address - Fax:
Practice Address - Street 1:1A TROLLEY SQ
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3334
Practice Address - Country:US
Practice Address - Phone:302-655-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0015967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist