Healthcare Provider Details

I. General information

NPI: 1770190886
Provider Name (Legal Business Name): DR. MARK MORCKOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19781 RINALDI ST
NORTHRIDGE CA
91326-4143
US

IV. Provider business mailing address

19781 RINALDI ST
PORTER RANCH CA
91326-4143
US

V. Phone/Fax

Practice location:
  • Phone: 818-832-3156
  • Fax:
Mailing address:
  • Phone: 818-832-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83351
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number83351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: