Provider Demographics
NPI:1487904538
Name:HARRIS, TANYA LOUISE (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:LOUISE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:TANYA
Other - Middle Name:LOUISE
Other - Last Name:HARRIS PHILLIP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:5214 SW 79TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7405
Mailing Address - Country:US
Mailing Address - Phone:352-226-5572
Mailing Address - Fax:
Practice Address - Street 1:5214 SW 79TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-7405
Practice Address - Country:US
Practice Address - Phone:352-226-5572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist