Provider Demographics
NPI:1912178559
Name:HARRIS, MICHAEL ALAN (RPH, MS, MBA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALAN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RPH, MS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N CHAUCER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IL
Mailing Address - Zip Code:61856-2321
Mailing Address - Country:US
Mailing Address - Phone:217-935-1357
Mailing Address - Fax:
Practice Address - Street 1:320 N CHAUCER BLVD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-2321
Practice Address - Country:US
Practice Address - Phone:217-762-7409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-028329183500000X
IN26012574A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist