Healthcare Provider Details

I. General information

NPI: 1396479499
Provider Name (Legal Business Name): JACOB MORRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 STAGE RD
BARTLETT TN
38134-8378
US

IV. Provider business mailing address

3685 S HOUSTON LEVEE RD
COLLIERVILLE TN
38017-9009
US

V. Phone/Fax

Practice location:
  • Phone: 901-387-7097
  • Fax:
Mailing address:
  • Phone: 901-854-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number023281
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number46477
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46477
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: