Provider Demographics
NPI:1447309414
Name:HARRISON DRUG
Entity type:Organization
Organization Name:HARRISON DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-489-8806
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:25372 HIGHWAY 195
Mailing Address - City:DOUBLE SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:35553-0505
Mailing Address - Country:US
Mailing Address - Phone:205-489-8806
Mailing Address - Fax:205-489-8422
Practice Address - Street 1:25372 HIGHWAY 195
Practice Address - Street 2:
Practice Address - City:DOUBLE SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:35553
Practice Address - Country:US
Practice Address - Phone:205-489-8806
Practice Address - Fax:205-489-8422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL105153333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002631Medicaid
0125030OtherNCPDP