Provider Demographics
NPI:1033499645
Name:HARRIS, SHALA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHALA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8917 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5012
Mailing Address - Country:US
Mailing Address - Phone:904-636-8186
Mailing Address - Fax:904-636-8191
Practice Address - Street 1:8917 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5012
Practice Address - Country:US
Practice Address - Phone:904-636-8186
Practice Address - Fax:904-636-8191
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist