Provider Demographics
NPI:1770881914
Name:HARKNESS, RENEE DAWN (RPH)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:DAWN
Last Name:HARKNESS
Suffix:
Gender:F
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:RR 2 BOX 1AA
Mailing Address - Street 2:1490 EAST MAIN ST
Mailing Address - City:HARRISVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26362-9602
Mailing Address - Country:US
Mailing Address - Phone:304-643-2902
Mailing Address - Fax:304-643-2834
Practice Address - Street 1:RR 2 BOX 1AA
Practice Address - Street 2:1490 EAST MAIN ST
Practice Address - City:HARRISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26362-9602
Practice Address - Country:US
Practice Address - Phone:304-643-2902
Practice Address - Fax:304-643-2834
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-12
Last Update Date:2011-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV5009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist