Provider Demographics
NPI:1477386035
Name:HARRIS, ULYSSES III (PHARMD)
Entity type:Individual
Prefix:
First Name:ULYSSES
Middle Name:
Last Name:HARRIS
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:TRE
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:908 TEMPLE DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-3928
Mailing Address - Country:US
Mailing Address - Phone:321-289-7195
Mailing Address - Fax:
Practice Address - Street 1:3171 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6193
Practice Address - Country:US
Practice Address - Phone:407-204-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS67531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist