Provider Demographics
NPI:1497354245
Name:HARRIS, WESLEY O'NEAL (PHARMD, AAHIVE)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:O'NEAL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHARMD, AAHIVE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 GIBBS RD
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-2408
Mailing Address - Country:US
Mailing Address - Phone:334-414-1030
Mailing Address - Fax:
Practice Address - Street 1:13620 HIGHWAY 43 N
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35475-4580
Practice Address - Country:US
Practice Address - Phone:205-333-0321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0022746183500000X
AL21044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist