Provider Demographics
NPI:1811138399
Name:MEDRICK MORRIS
Entity type:Organization
Organization Name:MEDRICK MORRIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MEDRICK
Authorized Official - Middle Name:MASON
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-731-0880
Mailing Address - Street 1:14455 CULLEN BLVD
Mailing Address - Street 2:STE. C-1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-4800
Mailing Address - Country:US
Mailing Address - Phone:713-731-0880
Mailing Address - Fax:713-731-2005
Practice Address - Street 1:14455 CULLEN BLVD
Practice Address - Street 2:STE. C-1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-4800
Practice Address - Country:US
Practice Address - Phone:713-731-0880
Practice Address - Fax:713-731-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26341333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149254Medicaid