Provider Demographics
NPI:1790067171
Name:BLOM, MORGAN M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:M
Last Name:BLOM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6945 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-9316
Mailing Address - Country:US
Mailing Address - Phone:904-284-0848
Mailing Address - Fax:904-284-1645
Practice Address - Street 1:6945 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-9316
Practice Address - Country:US
Practice Address - Phone:904-284-0848
Practice Address - Fax:904-284-1645
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL42570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist