MEDICARE: DR. PETRONILO MORIN IV PHARMD

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	72991	TX
2	1835N0905X	Nuclear Pharmacist	72991	TX

General Provider Information

NPI Number	:	1811752033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETRONILO MORIN IV PHARMD

Provider Business Mailing Address
First Line	:	4201 ARMORY RD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76302-2207
Country	:	US
Telephone Number	:	940-761-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 ARMORY RD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76302-2207
Country	:	US
Telephone Number	:	940-761-1110
Fax Number	:

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

Provider Enumeration Date	:	02/16/2024
Last Update Date	:	02/16/2024

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