Provider Demographics
NPI:1356956254
Name:HARRISON, PHIL (RPH)
Entity type:Individual
Prefix:
First Name:PHIL
Middle Name:
Last Name:HARRISON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75442-3322
Mailing Address - Country:US
Mailing Address - Phone:972-784-7519
Mailing Address - Fax:
Practice Address - Street 1:1402 WILLOW LN
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442-3322
Practice Address - Country:US
Practice Address - Phone:972-784-7519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist