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Dr. Phillip R Harston

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NPI Number Detailed Information

Provider Information:

Name: Dr. Phillip R Harston
Gender: M
Provider License Number If Given: 26667

NPI Information:

NPI: 1497758411
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 5/23/2005

Last Update Date: 3/11/2015

Provider Business Mailing Address:

Address: PO BOX 60447
Charlotte, NC 28260
Phone Number: 7043334104
Fax Number: 7043584544

Provider Business Practice Location Address:

Address: 2711 RANDOLPH RD STE 512
Charlotte, NC 28207
Phone Number: 7043334104
Fax Number: 7043584544

Provider Taxonomy:

Primary: 207V00000X
Secondary (if any):
State: NC

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