=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164704987
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID MORRIS DECUIR RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2011
-----------------------------------------------------
Last Update Date | 09/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 807 S HIGHWAY 53
-----------------------------------------------------
City | LA GRANGE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40031-9531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-222-6550
-----------------------------------------------------
Fax | 502-222-6650
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 807 S HIGHWAY 53
-----------------------------------------------------
City | LA GRANGE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40031-9531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-222-6550
-----------------------------------------------------
Fax | 502-222-6650
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 011639
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------