Provider Demographics
NPI:1215508734
Name:MORGAN, SHANE ALLEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:ALLEN
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3701 RATCLIFFE RD
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-4351
Mailing Address - Country:US
Mailing Address - Phone:276-393-1317
Mailing Address - Fax:276-679-1128
Practice Address - Street 1:671 HIGHWAY 58 E
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-3007
Practice Address - Country:US
Practice Address - Phone:276-679-8042
Practice Address - Fax:276-679-1128
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA00202012459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist