Provider Demographics
NPI:1508547258
Name:HARRIS, BOBBY CLIFFORD
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:CLIFFORD
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10435 MIDTOWN PKWY UNIT 332
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7472
Mailing Address - Country:US
Mailing Address - Phone:352-942-9495
Mailing Address - Fax:
Practice Address - Street 1:4567 RIVER CITY DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7411
Practice Address - Country:US
Practice Address - Phone:904-596-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist