Provider Demographics
NPI:1578676193
Name:HARRISON, GWENDOLYN O (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:O
Last Name:HARRISON
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 1:1504 SPRINGHILL AVENUE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604
Mailing Address - Country:US
Mailing Address - Phone:251-219-3711
Mailing Address - Fax:251-219-3947
Practice Address - Street 1:1504 SPRING HILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3207
Practice Address - Country:US
Practice Address - Phone:251-219-3711
Practice Address - Fax:251-219-3947
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist