1386829877 NPI number — DR. REGINAL D HARRIS PHARMD, RPH, CPH

Table of content: DR. REGINAL D HARRIS PHARMD, RPH, CPH (NPI 1386829877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386829877 NPI number — DR. REGINAL D HARRIS PHARMD, RPH, CPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
REGINAL
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD, RPH, CPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386829877
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 382
Provider Second Line Business Mailing Address:
INFOSOURCE COMMUNICATIONS, LLC
Provider Business Mailing Address City Name:
CONVERSE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78109-0382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-896-1666
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12702 TOEPPERWEIN RD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
LIVE OAK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78233-3278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-896-1666
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  38076 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: PS 32996 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835P1200X , with the licence number: PU 5737 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835G0303X , with the licence number: 38076 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835P0018X , with the licence number: 38076 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835P1200X , with the licence number: 38076 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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