Healthcare Provider Details

I. General information

NPI: 1598712887
Provider Name (Legal Business Name): DAVID JOHN MORGAN SR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5584 S WISHING WELL DR
FORT MOHAVE AZ
86426-8850
US

IV. Provider business mailing address

5584 S WISHING WELL DR
FORT MOHAVE AZ
86426-8850
US

V. Phone/Fax

Practice location:
  • Phone: 928-208-2380
  • Fax:
Mailing address:
  • Phone: 928-208-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5536
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: