Provider Demographics
NPI:1316220411
Name:HARRIES, LANCE A (RPH)
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:A
Last Name:HARRIES
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 1:1171 W 2000 N
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1638
Mailing Address - Country:US
Mailing Address - Phone:801-614-1302
Mailing Address - Fax:801-614-1328
Practice Address - Street 1:1171 W 2000 N
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1638
Practice Address - Country:US
Practice Address - Phone:801-614-1302
Practice Address - Fax:801-614-1328
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT154008-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist