Healthcare Provider Details

I. General information

NPI: 1124844584
Provider Name (Legal Business Name): MADELINE MORRICAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2057 W REVAYAH PL
TUCSON AZ
85704-1498
US

IV. Provider business mailing address

2057 W REVAYAH PL
TUCSON AZ
85704-1498
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax:
Mailing address:
  • Phone: 520-792-1450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number3071741
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3071741
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: