Provider Demographics
NPI:1497096754
Name:BERNARD, MORGAN LEIGH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:LEIGH
Last Name:BERNARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:LEIGH
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:145 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3423
Mailing Address - Country:US
Mailing Address - Phone:920-926-4660
Mailing Address - Fax:920-922-5011
Practice Address - Street 1:145 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3423
Practice Address - Country:US
Practice Address - Phone:920-926-4660
Practice Address - Fax:920-922-5011
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16653-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist