Provider Demographics
NPI:1871861054
Name:HARRIS, DOUGLAS ALLEN (RPH)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALLEN
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 1:15187 STONE HORSE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-1517
Mailing Address - Country:US
Mailing Address - Phone:804-749-8623
Mailing Address - Fax:
Practice Address - Street 1:16151 TRAINHAM RD
Practice Address - Street 2:
Practice Address - City:BEAVERDAM
Practice Address - State:VA
Practice Address - Zip Code:23015-1301
Practice Address - Country:US
Practice Address - Phone:804-449-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist