Provider Demographics
NPI:1447863113
Name:HARRIS, COLLIN (PHARMD)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 FRAZEE ST E
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3603
Mailing Address - Country:US
Mailing Address - Phone:218-847-1484
Mailing Address - Fax:218-847-1486
Practice Address - Street 1:329 FRAZEE ST E
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3603
Practice Address - Country:US
Practice Address - Phone:218-847-1484
Practice Address - Fax:218-847-1486
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist