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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 |
