=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740322015
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN THATCHER MORALES RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 08/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 N IMPERIAL AVE
-----------------------------------------------------
City | EL CENTRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92243-1914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-353-2720
-----------------------------------------------------
Fax | 760-353-3591
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2460 W HEIL AVE
-----------------------------------------------------
City | EL CENTRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92243-3530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-455-2596
-----------------------------------------------------
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 | RPH 53329
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------