Provider Demographics
NPI:1366882128
Name:HARRIS, KRISTEN DENISE (PHARM, D,)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:DENISE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHARM, D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 W COMMERCIAL BLVD
Mailing Address - Street 2:T-1778
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4301
Mailing Address - Country:US
Mailing Address - Phone:954-572-6724
Mailing Address - Fax:954-578-4539
Practice Address - Street 1:7730 W COMMERCIAL BLVD
Practice Address - Street 2:T-1778
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-4301
Practice Address - Country:US
Practice Address - Phone:954-572-6724
Practice Address - Fax:954-578-4539
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 50210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist