Provider Demographics
NPI:1912500380
Name:HARRIS, CROSBY GRANT (PHARM D)
Entity Type:Individual
Prefix:
First Name:CROSBY
Middle Name:GRANT
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-1253
Mailing Address - Country:US
Mailing Address - Phone:606-365-2164
Mailing Address - Fax:606-365-1181
Practice Address - Street 1:105 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1253
Practice Address - Country:US
Practice Address - Phone:160-636-5216
Practice Address - Fax:606-365-1181
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY016008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist