Healthcare Provider Details

I. General information

NPI: 1699111963
Provider Name (Legal Business Name): THOMAS MORRISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S MADISON AVE
AURORA MO
65605-1427
US

IV. Provider business mailing address

124 S MADISON AVE
AURORA MO
65605-1427
US

V. Phone/Fax

Practice location:
  • Phone: 417-678-4136
  • Fax: 417-678-2014
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040857
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: