Provider Demographics
NPI:1164839510
Name:HARRIS, TYLER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:HARRIS
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 1:1480 RUTH RD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-4413
Mailing Address - Country:US
Mailing Address - Phone:727-504-2386
Mailing Address - Fax:
Practice Address - Street 1:11880 28TH ST N STE 100
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1824
Practice Address - Country:US
Practice Address - Phone:727-302-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist