Provider Demographics
NPI:1346657129
Name:MORGAN STREET PHARMACY LLC
Entity Type:Organization
Organization Name:MORGAN STREET PHARMACY LLC
Other - Org Name:RALEIGH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:VANITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOGENDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-800-7485
Mailing Address - Street 1:927 W MORGAN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1600
Mailing Address - Country:US
Mailing Address - Phone:919-703-0154
Mailing Address - Fax:
Practice Address - Street 1:927 W MORGAN ST
Practice Address - Street 2:STE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1600
Practice Address - Country:US
Practice Address - Phone:919-703-0154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC120443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy