Provider Demographics
NPI:1912033382
Name:HARRIS, GARY STEVEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:STEVEN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 BULL LEA RD
Mailing Address - Street 2:SUITE 102B
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1209
Mailing Address - Country:US
Mailing Address - Phone:859-277-2271
Mailing Address - Fax:859-277-1532
Practice Address - Street 1:1501 BULL LEA RD
Practice Address - Street 2:SUITE 102B
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1209
Practice Address - Country:US
Practice Address - Phone:859-277-2271
Practice Address - Fax:859-277-1532
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011554183500000X, 1835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835N0905XPharmacy Service ProvidersPharmacistNuclear
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL13333OtherPHARMACIST LICENSE
KY011554OtherPHARMACIST LICENSE
TN10041OtherPHARMACIST LICENSE