Provider Demographics
NPI:1639507759
Name:HARRISBURG PHARMACY, PLLC
Entity Type:Organization
Organization Name:HARRISBURG PHARMACY, PLLC
Other - Org Name:HARRISBURG PHARMACY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:SHIMITRE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-928-2100
Mailing Address - Street 1:7321 HARRISBURG BLVD STE C-1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77011-4738
Mailing Address - Country:US
Mailing Address - Phone:713-928-2100
Mailing Address - Fax:713-928-2101
Practice Address - Street 1:7321 HARRISBURG BLVD STE C-1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-4738
Practice Address - Country:US
Practice Address - Phone:713-928-2100
Practice Address - Fax:713-928-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX287583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142525OtherPK