Provider Demographics
NPI:1558417626
Name:HARRILL, GARY LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:HARRILL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 RALPH HANDSEL BLVD
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-1447
Mailing Address - Country:US
Mailing Address - Phone:704-263-8084
Mailing Address - Fax:704-827-7134
Practice Address - Street 1:125 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-1616
Practice Address - Country:US
Practice Address - Phone:704-827-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700965OtherMEDICAID DME
NC0365148Medicaid