Provider Demographics
NPI:1437290947
Name:HARRIS PHARMACY, INC
Entity Type:Organization
Organization Name:HARRIS PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:GUPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-496-3543
Mailing Address - Street 1:105 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-2570
Mailing Address - Country:US
Mailing Address - Phone:919-496-3543
Mailing Address - Fax:919-496-9989
Practice Address - Street 1:105 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2570
Practice Address - Country:US
Practice Address - Phone:919-496-3543
Practice Address - Fax:919-496-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05191332B00000X, 332BP3500X, 3336C0003X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0316XOtherBLUE CROSS BLUE SHIELD
NC0355016Medicaid
NC0316XOtherBLUE CROSS BLUE SHIELD