Provider Demographics
NPI:1558418574
Name:MORGAN, JOHN M (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71343-2002
Mailing Address - Country:US
Mailing Address - Phone:318-339-8532
Mailing Address - Fax:318-339-8534
Practice Address - Street 1:1806 FOURTH ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71343-2002
Practice Address - Country:US
Practice Address - Phone:318-339-8532
Practice Address - Fax:318-339-8534
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1924629OtherNABP
LA1260746Medicaid