Provider Demographics
NPI:1073874111
Name:MORRIS, NECOLE JEAN (RPH)
Entity Type:Individual
Prefix:
First Name:NECOLE
Middle Name:JEAN
Last Name:MORRIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 NW GREENBRIAR PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3431
Mailing Address - Country:US
Mailing Address - Phone:805-680-3472
Mailing Address - Fax:
Practice Address - Street 1:2080 NW 9TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1484
Practice Address - Country:US
Practice Address - Phone:541-753-2226
Practice Address - Fax:541-753-2559
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0008790183500000X
CA51140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist