Provider Demographics
NPI:1417270463
Name:GARRISON, LEWAYNE MORSE (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEWAYNE
Middle Name:MORSE
Last Name:GARRISON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 CEDARWEED BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1067
Mailing Address - Country:US
Mailing Address - Phone:719-250-0269
Mailing Address - Fax:719-267-3468
Practice Address - Street 1:4610 CEDARWEED BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1067
Practice Address - Country:US
Practice Address - Phone:719-250-0269
Practice Address - Fax:719-267-3468
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO111091835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy