Provider Demographics
NPI:1225881550
Name:KOTVA, MORGAN VICTORIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:VICTORIA
Last Name:KOTVA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1227
Mailing Address - Country:US
Mailing Address - Phone:636-273-5206
Mailing Address - Fax:
Practice Address - Street 1:100 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1227
Practice Address - Country:US
Practice Address - Phone:636-273-5206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023050629183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist