Provider Demographics
NPI:1497862338
Name:HARRISON, BRIAN K (DPH)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:K
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 59
Mailing Address - Street 2:8 BRIAN STREET
Mailing Address - City:CARNEGIE
Mailing Address - State:OK
Mailing Address - Zip Code:73015-9607
Mailing Address - Country:US
Mailing Address - Phone:580-654-2246
Mailing Address - Fax:580-654-1229
Practice Address - Street 1:11 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:OK
Practice Address - Zip Code:73015
Practice Address - Country:US
Practice Address - Phone:580-654-1111
Practice Address - Fax:580-654-1229
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist