Healthcare Provider Details

I. General information

NPI: 1063086288
Provider Name (Legal Business Name): MORGAN MASTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 01/31/2024
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 S ANN ARBOR AVE
OKLAHOMA CITY OK
73128-1112
US

IV. Provider business mailing address

4913 W RENO AVE
OKLAHOMA CITY OK
73127-6339
US

V. Phone/Fax

Practice location:
  • Phone: 405-948-4900
  • Fax: 405-948-4933
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number17666
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: