Provider Demographics
NPI:1386101640
Name:HARRISON, CHAD ELLIS (PHARMD)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:ELLIS
Last Name:HARRISON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5993 E FLOWING SPG
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-7950
Mailing Address - Country:US
Mailing Address - Phone:415-580-1895
Mailing Address - Fax:
Practice Address - Street 1:5993 E FLOWING SPG
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-7950
Practice Address - Country:US
Practice Address - Phone:415-580-1895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist