Healthcare Provider Details

I. General information

NPI: 1730832767
Provider Name (Legal Business Name): MORGAN LEE MALLETTE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 01/31/2022
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 US-80 E
CLINTON MS
39056
US

IV. Provider business mailing address

306 AFTON DR
BRANDON MS
39042-3651
US

V. Phone/Fax

Practice location:
  • Phone: 601-926-1179
  • Fax:
Mailing address:
  • Phone: 601-513-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE100440
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: