Provider Demographics
NPI:1770812653
Name:MORRIS, JINA (RPH)
Entity type:Individual
Prefix:
First Name:JINA
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574
Mailing Address - Country:US
Mailing Address - Phone:512-352-3469
Mailing Address - Fax:512-352-3794
Practice Address - Street 1:1610 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574
Practice Address - Country:US
Practice Address - Phone:512-352-3469
Practice Address - Fax:512-352-3794
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist