Provider Demographics
NPI:1750491916
Name:HARRIS, JILL MCCORTNEY (PHARM D)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MCCORTNEY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2626
Mailing Address - Country:US
Mailing Address - Phone:580-332-3344
Mailing Address - Fax:
Practice Address - Street 1:1300 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2626
Practice Address - Country:US
Practice Address - Phone:580-332-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist