Healthcare Provider Details

I. General information

NPI: 1720256159
Provider Name (Legal Business Name): JAY CARL MORGAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 5 BOX 446
ESPANOLA NM
87532-8908
US

IV. Provider business mailing address

6308 AMBERSIDE RD NW
ALBUQUERQUE NM
87120-6208
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-9421
  • Fax: 505-753-5039
Mailing address:
  • Phone: 505-244-1832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00005938
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: