Provider Demographics
NPI:1639204738
Name:MORGAN'S PHARMACY OF GILBERT, LLC
Entity Type:Organization
Organization Name:MORGAN'S PHARMACY OF GILBERT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-360-9650
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29054-0346
Mailing Address - Country:US
Mailing Address - Phone:803-892-5572
Mailing Address - Fax:803-892-2930
Practice Address - Street 1:309 BROAD ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:SC
Practice Address - Zip Code:29054-8587
Practice Address - Country:US
Practice Address - Phone:803-892-5572
Practice Address - Fax:803-892-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 333600000X
SC31613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2090768OtherPK
SC731610Medicaid
SC731610Medicaid