Provider Demographics
NPI:1710669551
Name:HARRIS, DERRICK LAMONT (PHARMD)
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:LAMONT
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15200 QUIET FOREST CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23834-5442
Mailing Address - Country:US
Mailing Address - Phone:804-715-2511
Mailing Address - Fax:
Practice Address - Street 1:6400 IRON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-5204
Practice Address - Country:US
Practice Address - Phone:804-271-8361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist