Provider Demographics
NPI:1790931335
Name:HARRIS, KENNETH HAL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HAL
Last Name:HARRIS
Suffix:
Gender:M
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 1:1776 AVALON ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4624
Mailing Address - Country:US
Mailing Address - Phone:541-882-3372
Mailing Address - Fax:541-882-3419
Practice Address - Street 1:1776 AVALON ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4624
Practice Address - Country:US
Practice Address - Phone:541-882-3372
Practice Address - Fax:541-882-3419
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010344183500000X
AK1559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist