Provider Demographics
NPI:1568099075
Name:HARRIS, FAITH DC (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FAITH
Middle Name:DC
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 1:151 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06156-0001
Mailing Address - Country:US
Mailing Address - Phone:959-230-6368
Mailing Address - Fax:
Practice Address - Street 1:151 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06156-3427
Practice Address - Country:US
Practice Address - Phone:959-230-6368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209640183500000X, 3336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy