Provider Demographics
NPI:1376081257
Name:MORRILL, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:MORRILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MANOR HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1312
Mailing Address - Country:US
Mailing Address - Phone:413-563-6333
Mailing Address - Fax:
Practice Address - Street 1:1-5 ST. JAMES AVE
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020
Practice Address - Country:US
Practice Address - Phone:413-557-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH237187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist