Provider Demographics
NPI:1760807077
Name:HARRIS, DIRK (RPH)
Entity Type:Individual
Prefix:
First Name:DIRK
Middle Name:
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 1:504 N MESA RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-9340
Mailing Address - Country:US
Mailing Address - Phone:765-284-8456
Mailing Address - Fax:765-284-8456
Practice Address - Street 1:504 N MESA RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-9340
Practice Address - Country:US
Practice Address - Phone:765-284-8456
Practice Address - Fax:765-284-8456
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-23
Last Update Date:2014-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016629A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist