Provider Demographics
NPI:1265566558
Name:MORGAN, ABRAHAM CORNELIUS (RPH)
Entity type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:CORNELIUS
Last Name:MORGAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 N LASALLE STREET
Mailing Address - Street 2:SUITE B 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610
Mailing Address - Country:US
Mailing Address - Phone:312-276-1040
Mailing Address - Fax:312-376-1050
Practice Address - Street 1:747 N LASALLE STREET
Practice Address - Street 2:SUITE B 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610
Practice Address - Country:US
Practice Address - Phone:312-276-1040
Practice Address - Fax:312-376-1050
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist