Provider Demographics
NPI:1396462115
Name:CRAIN, MORGAN (PHARMD)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:CRAIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MORGAN ROBERTS
Mailing Address - Street 1:2201 CHEROKEE RD APT 18
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3478
Mailing Address - Country:US
Mailing Address - Phone:606-369-0096
Mailing Address - Fax:
Practice Address - Street 1:401 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1207
Practice Address - Country:US
Practice Address - Phone:423-743-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN46400OtherPHARMACY LICENSE NUMBER