Healthcare Provider Details

I. General information

NPI: 1881218733
Provider Name (Legal Business Name): MORGAN ELIZABETH COE CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN ELIZABETH TOBIAS CPHT

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HUNT LN
POTTS CAMP MS
38659-9247
US

IV. Provider business mailing address

22 HUNT LN
POTTS CAMP MS
38659-9247
US

V. Phone/Fax

Practice location:
  • Phone: 810-449-8654
  • Fax:
Mailing address:
  • Phone: 810-449-8654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT-218499
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: