Healthcare Provider Details

I. General information

NPI: 1225141849
Provider Name (Legal Business Name): MARK GEORGE HARRIS PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FREEDOM WAY DEPT OF VETERANS AFFAIRS
AUGUSTA GA
30904
US

IV. Provider business mailing address

1006 BRIARCREEK RD
JACKSONVILLE FL
32225-5310
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax: 706-823-3968
Mailing address:
  • Phone: 904-928-9801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS39100
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number018495
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: