Healthcare Provider Details

I. General information

NPI: 1912377912
Provider Name (Legal Business Name): JAMES MORGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 BENNETT RD
NEW GLOUCESTER ME
04260-4059
US

IV. Provider business mailing address

167 BENNETT RD
NEW GLOUCESTER ME
04260-4059
US

V. Phone/Fax

Practice location:
  • Phone: 207-653-0295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR27873
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: