Provider Demographics
NPI:1659127249
Name:WALIZER, MORGAN LEIGH (CPHT)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:LEIGH
Last Name:WALIZER
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CONFER FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-6502
Mailing Address - Country:US
Mailing Address - Phone:570-419-2201
Mailing Address - Fax:
Practice Address - Street 1:313-337 WEST BALD EAGLE STREET
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745
Practice Address - Country:US
Practice Address - Phone:570-748-1790
Practice Address - Fax:570-748-7631
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1235162561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist