Provider Demographics
NPI:1467709832
Name:HARRIS, MYRA (PHARM D, RPH)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:MYRA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D, RPH
Mailing Address - Street 1:75 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3625
Mailing Address - Country:US
Mailing Address - Phone:802-878-3369
Mailing Address - Fax:
Practice Address - Street 1:75 PEARL ST
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3625
Practice Address - Country:US
Practice Address - Phone:802-878-3369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-05
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0086042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist