Provider Demographics
NPI:1891395844
Name:MORRISON, EVAN REID (PHARMD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:REID
Last Name:MORRISON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 TRUMAN AVE APT F
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2695
Mailing Address - Country:US
Mailing Address - Phone:314-580-2874
Mailing Address - Fax:
Practice Address - Street 1:500 S BISHOP AVE
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4497
Practice Address - Country:US
Practice Address - Phone:573-364-4339
Practice Address - Fax:573-341-2304
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020018411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist