Provider Demographics
NPI:1760777163
Name:HARRIS, CHARLES F (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 N HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5291
Mailing Address - Country:US
Mailing Address - Phone:972-923-9169
Mailing Address - Fax:469-383-3258
Practice Address - Street 1:1316 N HIGHWAY 77
Practice Address - Street 2:TARGET 1962
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5116
Practice Address - Country:US
Practice Address - Phone:972-923-9169
Practice Address - Fax:972-923-9169
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist