Provider Demographics
NPI:1194007096
Name:MORGAN, JACQUELINE (PHARM D)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:JAQUELINE
Other - Middle Name:
Other - Last Name:PUGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 S. PAVILION RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144
Mailing Address - Country:US
Mailing Address - Phone:702-352-2055
Mailing Address - Fax:
Practice Address - Street 1:6825 N DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4594
Practice Address - Country:US
Practice Address - Phone:702-260-8242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist