Basic Information
| Provider Information | |||||||||
| NPI: | 1225141849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | GEORGE | ||||||||
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| Credential: | PHARMACIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1006 BRIARCREEK RD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322255310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9049289801 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1 FREEDOM WAY | ||||||||
| Address2: | DEPT OF VETERANS AFFAIRS | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067330188 | ||||||||
| FaxNumber: | 7068233968 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS39100 | FL | N | Pharmacy Service Providers | Pharmacist | 183500000X | 018495 | GA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.