Provider Demographics
NPI:1851938633
Name:BADER, MORGAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:BADER
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 1:375 TRIMMER LN
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63638-7972
Mailing Address - Country:US
Mailing Address - Phone:573-663-7707
Mailing Address - Fax:
Practice Address - Street 1:375 TRIMMER LN
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:MO
Practice Address - Zip Code:63638-7972
Practice Address - Country:US
Practice Address - Phone:573-663-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-29
Last Update Date:2019-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019028164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist