Provider Demographics
NPI:1861839227
Name:HARRIS, JENNIFER KALE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KALE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 FLUSHING DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-2151
Mailing Address - Country:US
Mailing Address - Phone:803-818-4305
Mailing Address - Fax:803-628-6278
Practice Address - Street 1:1095 FILBERT HWY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-2158
Practice Address - Country:US
Practice Address - Phone:803-628-6372
Practice Address - Fax:803-628-6278
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-25
Last Update Date:2013-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14422183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician