Provider Demographics
NPI:1598725392
Name:MORGAN, JESSIE DARYL (R PH, MHA)
Entity Type:Individual
Prefix:MR
First Name:JESSIE
Middle Name:DARYL
Last Name:MORGAN
Suffix:
Gender:M
Credentials:R PH, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 CARSON WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205
Mailing Address - Country:US
Mailing Address - Phone:502-458-3808
Mailing Address - Fax:502-562-6751
Practice Address - Street 1:530 SOUTH JACKSON STREET
Practice Address - Street 2:ACB PHARMACY
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-562-6742
Practice Address - Fax:502-562-6751
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist