Provider Demographics
NPI:1578188298
Name:HARRISON, DAIQUAUN DURAY (RPH)
Entity Type:Individual
Prefix:
First Name:DAIQUAUN
Middle Name:DURAY
Last Name:HARRISON
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 1:900 RIGGINS RD APT 322
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-2214
Mailing Address - Country:US
Mailing Address - Phone:678-358-5758
Mailing Address - Fax:
Practice Address - Street 1:1505 W REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4733
Practice Address - Country:US
Practice Address - Phone:813-659-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist