Provider Demographics
NPI:1558477091
Name:MORGAN, MARY J (DPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-3942
Mailing Address - Country:US
Mailing Address - Phone:918-756-3334
Mailing Address - Fax:918-756-4949
Practice Address - Street 1:309 N 14TH ST
Practice Address - Street 2:
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859-2028
Practice Address - Country:US
Practice Address - Phone:918-623-1424
Practice Address - Fax:918-623-2809
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist