Provider Demographics
NPI:1720256159
Name:MORGAN, JAY CARL (RPH)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:CARL
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 1:6308 AMBERSIDE RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-6208
Mailing Address - Country:US
Mailing Address - Phone:505-244-1832
Mailing Address - Fax:
Practice Address - Street 1:RR 5 BOX 446
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-8908
Practice Address - Country:US
Practice Address - Phone:505-753-9421
Practice Address - Fax:505-753-5039
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00005938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist