Provider Demographics
NPI:1972198463
Name:HARRIS, DARREN KEITH
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:KEITH
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 1ST ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-2528
Mailing Address - Country:US
Mailing Address - Phone:573-888-6006
Mailing Address - Fax:
Practice Address - Street 1:1224 1ST ST
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2528
Practice Address - Country:US
Practice Address - Phone:573-888-6006
Practice Address - Fax:573-888-1006
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO43908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist