Provider Demographics
NPI:1023150778
Name:HARRIS, CYNTHIA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 551066
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-1066
Mailing Address - Country:US
Mailing Address - Phone:904-614-9800
Mailing Address - Fax:904-614-9800
Practice Address - Street 1:1536 N JEFFERSON ST
Practice Address - Street 2:JOC PHARMACY DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6525
Practice Address - Country:US
Practice Address - Phone:904-475-5938
Practice Address - Fax:904-475-5938
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 39906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist