Provider Demographics
NPI:1972356699
Name:HARRIS, RICHARD JEFFREY
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JEFFREY
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 1:609 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2115
Mailing Address - Country:US
Mailing Address - Phone:251-282-0599
Mailing Address - Fax:
Practice Address - Street 1:185 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2404
Practice Address - Country:US
Practice Address - Phone:931-967-8368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist