Provider Demographics
NPI:1982211397
Name:MORGAN, BRADFORD LOUIS
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:LOUIS
Last Name:MORGAN
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 1:9084 FERRY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8404
Mailing Address - Country:US
Mailing Address - Phone:318-780-1698
Mailing Address - Fax:
Practice Address - Street 1:9084 FERRY CREEK DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-8404
Practice Address - Country:US
Practice Address - Phone:318-780-1698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA14520OtherPHARMACIST