Provider Demographics
NPI:1063735140
Name:HARRISON, NANCY MILBERT (RPH)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:MILBERT
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 SALEM CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SUNFISH LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55118-4720
Mailing Address - Country:US
Mailing Address - Phone:651-455-7533
Mailing Address - Fax:
Practice Address - Street 1:401 COUNTY ROAD 42 E
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-5706
Practice Address - Country:US
Practice Address - Phone:952-435-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist