Healthcare Provider Details

I. General information

NPI: 1265648901
Provider Name (Legal Business Name): DAVID PHILLIP MORGE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 W MAIN ST
LEBANON TN
37087-3209
US

IV. Provider business mailing address

547 RIDGECREST LN
LEBANON TN
37087-1363
US

V. Phone/Fax

Practice location:
  • Phone: 615-449-4330
  • Fax:
Mailing address:
  • Phone: 615-449-2343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number22805
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: