Provider Demographics
NPI:1770655565
Name:HARRIS PRESCRIPTION INC
Entity Type:Organization
Organization Name:HARRIS PRESCRIPTION INC
Other - Org Name:NATIONS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-726-8451
Mailing Address - Street 1:432 HOPKINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-1284
Mailing Address - Country:US
Mailing Address - Phone:270-726-8451
Mailing Address - Fax:270-726-8696
Practice Address - Street 1:432 HOPKINSVILLE RD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-1284
Practice Address - Country:US
Practice Address - Phone:270-726-8451
Practice Address - Fax:270-726-8696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
KYP025483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90140716Medicaid
KY54029186Medicaid
1822762OtherNCPDP PROVIDER IDENTIFICATION NUMBER
KY54029186Medicaid