Provider Demographics
NPI:1124337712
Name:MORROW, WADE
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:
Last Name:MORROW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2045
Mailing Address - Country:US
Mailing Address - Phone:307-234-7159
Mailing Address - Fax:307-237-0971
Practice Address - Street 1:2625 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2045
Practice Address - Country:US
Practice Address - Phone:307-234-7159
Practice Address - Fax:307-237-0971
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist