Provider Demographics
NPI:1821891920
Name:MORRELL, ELLIOT
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:MORRELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 S 1530 W
Mailing Address - Street 2:
Mailing Address - City:PINGREE
Mailing Address - State:ID
Mailing Address - Zip Code:83262-1258
Mailing Address - Country:US
Mailing Address - Phone:801-419-2378
Mailing Address - Fax:
Practice Address - Street 1:2325 CORONADO ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7407
Practice Address - Country:US
Practice Address - Phone:208-557-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP9171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist