Provider Demographics
NPI:1356424139
Name:HARRIS PHARMACY
Entity type:Organization
Organization Name:HARRIS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:HEWLETT
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:229-725-4911
Mailing Address - Street 1:465 N. W. PIONEER RD
Mailing Address - Street 2:PO BOX 220
Mailing Address - City:ARLINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:39813-0220
Mailing Address - Country:US
Mailing Address - Phone:229-725-4911
Mailing Address - Fax:
Practice Address - Street 1:465 N. W. PIONEER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:GA
Practice Address - Zip Code:39813-0220
Practice Address - Country:US
Practice Address - Phone:229-725-4911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00029235AMedicaid
GA5235770001Medicare ID - Type Unspecified