Provider Demographics
NPI:1437305273
Name:DIVEN, MORGANE C (PHARMD, BCOP)
Entity Type:Individual
Prefix:DR
First Name:MORGANE
Middle Name:C
Last Name:DIVEN
Suffix:
Gender:F
Credentials:PHARMD, BCOP
Other - Prefix:DR
Other - First Name:MORGANE
Other - Middle Name:C
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3838 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1478
Mailing Address - Country:US
Mailing Address - Phone:520-694-0398
Mailing Address - Fax:
Practice Address - Street 1:3838 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1478
Practice Address - Country:US
Practice Address - Phone:520-694-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS016693OtherPHARMACY LICENSE