Bryan David Harris
Individual provider Active NPI Pharmacist · Malden, MO
NPI 1306459490 · NPPES record last updated Aug 28, 2020
Key facts
- NPI
- 1306459490
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 042982 (MO)
- Practice address
- 310 W Main St
Malden, MO 63863-2116 - Phone
- (573) 281-6964
- Fax
- (573) 276-4785
- NPI assigned
- Aug 28, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042982 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current |
Accepting new patients | |
| Walgreen Co | Past |
Accepting new patients |
Locations
310 W Main St
Malden, MO 63863
Phone (573) 276-2218
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 042982 | MO | Yes |
Addresses
Primary practice location
310 W Main St
Malden, MO 63863-2116
Mailing address
310 W Main St
Malden, MO 63863-2116
Phone (573) 281-6964
Other providers in Malden, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.