Provider Demographics
NPI:1841754819
Name:MORGAN, HEATHER (RPH)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:DANE
Mailing Address - State:WI
Mailing Address - Zip Code:53529-9535
Mailing Address - Country:US
Mailing Address - Phone:608-516-8916
Mailing Address - Fax:
Practice Address - Street 1:8202 EXCELSIOR DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1906
Practice Address - Country:US
Practice Address - Phone:608-831-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13097-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist