Provider Demographics
NPI:1659860773
Name:HARRIS, HEATHER RAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RAE
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 1:317 N WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:RED CLOUD
Mailing Address - State:NE
Mailing Address - Zip Code:68970-2549
Mailing Address - Country:US
Mailing Address - Phone:402-746-3335
Mailing Address - Fax:402-746-3355
Practice Address - Street 1:317 N WEBSTER ST
Practice Address - Street 2:
Practice Address - City:RED CLOUD
Practice Address - State:NE
Practice Address - Zip Code:68970-2549
Practice Address - Country:US
Practice Address - Phone:402-746-3335
Practice Address - Fax:402-746-3355
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE15485OtherNEBRASKA BOARD OF PHARMACY