Provider Demographics
NPI:1619642295
Name:MORRISON, TINA M
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:MORRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 COVERT RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1019
Mailing Address - Country:US
Mailing Address - Phone:810-293-6148
Mailing Address - Fax:
Practice Address - Street 1:6026 LAPEER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-2215
Practice Address - Country:US
Practice Address - Phone:810-742-3010
Practice Address - Fax:810-742-6560
Is Sole Proprietor?:No
Enumeration Date:2021-08-15
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1501571183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician