Provider Demographics
NPI:1497112031
Name:MORRIS, MALCOLM THOMAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:THOMAS
Last Name:MORRIS
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 1:15603 SE 177TH PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9008
Mailing Address - Country:US
Mailing Address - Phone:425-591-4124
Mailing Address - Fax:
Practice Address - Street 1:15603 SE 177TH PL
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-9008
Practice Address - Country:US
Practice Address - Phone:425-591-4124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist