Provider Demographics
NPI:1881110104
Name:HARRISON, HAROLD DOUGLAS (RPH)
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:DOUGLAS
Last Name:HARRISON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12103 KEMP DR NW
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-3126
Mailing Address - Country:US
Mailing Address - Phone:304-707-1154
Mailing Address - Fax:
Practice Address - Street 1:22630 NORTHWESTERN PIKE
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-6379
Practice Address - Country:US
Practice Address - Phone:304-822-1000
Practice Address - Fax:304-822-2423
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0003168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist