MEDICARE: GARY MORGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH60064750	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417320425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY MORGAN

Provider Business Mailing Address
First Line	:	523 N PINES RD
Second Line	:	SUITE C
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-6134
Country	:	US
Telephone Number	:	509-928-9698
Fax Number	:	509-928-0509

Provider Business Practice Location Address
First Line	:	523 N PINES RD
Second Line	:	SUITE C
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-6134
Country	:	US
Telephone Number	:	509-928-9698
Fax Number	:	509-928-0509

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	11/12/2015

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