MEDICARE: RODALYN MORINE RPH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	39604	TX

General Provider Information

NPI Number	:	1346468691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODALYN MORINE RPH.

Provider Business Mailing Address
First Line	:	1352 GREEN HILLS CT
Second Line	:
City	:	DUNCANVILLE
State	:	TX
Zip	:	75137-2842
Country	:	US
Telephone Number	:	972-572-4244
Fax Number	:	972-572-4244

Provider Business Practice Location Address
First Line	:	6303 FOREST PARK RD
Second Line	:	SUITE 255-A
City	:	DALLAS
State	:	TX
Zip	:	75235-5450
Country	:	US
Telephone Number	:	214-357-8889
Fax Number	:	214-357-8370

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	02/14/2012

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