Provider Demographics
NPI:1245686591
Name:HARRISON, ROBERT DALE (BSPHARM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DALE
Last Name:HARRISON
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 OLD GREENSBORO RD
Mailing Address - Street 2:STE B
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-6855
Mailing Address - Country:US
Mailing Address - Phone:844-871-4773
Mailing Address - Fax:844-871-4776
Practice Address - Street 1:1601 OLD GREENSBORO RD
Practice Address - Street 2:STE B
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-6855
Practice Address - Country:US
Practice Address - Phone:844-871-4773
Practice Address - Fax:844-871-4776
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11764183500000X
AL18417183500000X
AZS021155183500000X
ARPD13115183500000X
FLPS 38395183500000X
HIPH 3848183500000X
IDP7238183500000X
KY17505183500000X
LAPST.020979183500000X
MD23042183500000X
MSP13841183500000X
NE14811183500000X
NHR2575183500000X
ORRPH-0014572183500000X
TN000038924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist