Provider Demographics
NPI:1821647520
Name:HARRIS, KELLI D (RPH)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:D
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 JOE B JACKSON PKWY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-7228
Mailing Address - Country:US
Mailing Address - Phone:615-907-8999
Mailing Address - Fax:
Practice Address - Street 1:140 JOE B JACKSON PKWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-7228
Practice Address - Country:US
Practice Address - Phone:615-907-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8983183500000X
CO15791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist