Provider Demographics
NPI:1144368820
Name:HARRIS, RANDALL EUGENE (RPH)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:EUGENE
Last Name:HARRIS
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 1:3110 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1080
Mailing Address - Country:US
Mailing Address - Phone:419-625-4191
Mailing Address - Fax:
Practice Address - Street 1:3416 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5557
Practice Address - Country:US
Practice Address - Phone:419-625-2454
Practice Address - Fax:419-609-2538
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-15388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist