Provider Demographics
NPI:1457831430
Name:HARRIS, KANDIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:KANDIS
Middle Name:
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 1:6438 SUNRISE SHADOW CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1100
Mailing Address - Country:US
Mailing Address - Phone:909-973-6754
Mailing Address - Fax:
Practice Address - Street 1:11720 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1572
Practice Address - Country:US
Practice Address - Phone:702-363-3306
Practice Address - Fax:702-363-3619
Is Sole Proprietor?:No
Enumeration Date:2018-08-18
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist