Provider Demographics
NPI:1235701806
Name:GILLUM, MORGAN NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:NICOLE
Last Name:GILLUM
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 1:1900 N POLK ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-4634
Mailing Address - Country:US
Mailing Address - Phone:501-663-3257
Mailing Address - Fax:
Practice Address - Street 1:1900 N POLK ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-4634
Practice Address - Country:US
Practice Address - Phone:501-663-3257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist