=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356176432
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN MORGAN PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2024
-----------------------------------------------------
Last Update Date | 09/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 73 N MAIN ST
-----------------------------------------------------
City | BROCKPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14420-1648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-637-1151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 456 WHITTIER RD
-----------------------------------------------------
City | SPENCERPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14559-9746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-362-2049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 071882
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------