Provider Demographics
NPI:1427228410
Name:MORGAN, MARY J
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:J
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 PAWLING AVE
Mailing Address - Street 2:CVS PHARMACY
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180
Mailing Address - Country:US
Mailing Address - Phone:518-273-6144
Mailing Address - Fax:518-271-9534
Practice Address - Street 1:541 PAWLING AVE
Practice Address - Street 2:CVS PHARMACY
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:518-273-6144
Practice Address - Fax:518-271-9534
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist