Provider Demographics
NPI:1710128012
Name:MORRIS, MEDRICK MASON
Entity Type:Individual
Prefix:
First Name:MEDRICK
Middle Name:MASON
Last Name:MORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14455 CULLEN BLVD
Mailing Address - Street 2:C-1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-4800
Mailing Address - Country:US
Mailing Address - Phone:713-731-0880
Mailing Address - Fax:713-731-2005
Practice Address - Street 1:14455 CULLEN BLVD
Practice Address - Street 2:C-1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-4800
Practice Address - Country:US
Practice Address - Phone:713-731-0880
Practice Address - Fax:713-731-2005
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist