Provider Demographics
NPI:1568202851
Name:OUELLETTE, MORGAN (PHARMD)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 STAFFORD AVE APT 39
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3862
Mailing Address - Country:US
Mailing Address - Phone:860-302-9911
Mailing Address - Fax:
Practice Address - Street 1:1309 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-3875
Practice Address - Country:US
Practice Address - Phone:860-348-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist