Provider Demographics
NPI:1972020204
Name:SPEIGHTS, HARRY LEWIS JR (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:LEWIS
Last Name:SPEIGHTS
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HWY 13 NORTH
Mailing Address - Street 2:1110 SUITE 5
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429
Mailing Address - Country:US
Mailing Address - Phone:601-736-3394
Mailing Address - Fax:601-736-3499
Practice Address - Street 1:HWY 13 N. 1110 SUITE 5
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429
Practice Address - Country:US
Practice Address - Phone:601-736-3394
Practice Address - Fax:601-736-3499
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-6974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05532313Medicaid