Provider Demographics
NPI:1699376897
Name:MORRELL, THOMAS JASON (PHARM-D)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JASON
Last Name:MORRELL
Suffix:
Gender:M
Credentials:PHARM-D
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:JASON
Other - Last Name:MORRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACY MANAGER
Mailing Address - Street 1:1851 W HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-4125
Mailing Address - Country:US
Mailing Address - Phone:435-789-9787
Mailing Address - Fax:435-789-1310
Practice Address - Street 1:1851 W HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-4125
Practice Address - Country:US
Practice Address - Phone:435-789-9787
Practice Address - Fax:435-789-1310
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15459183500000X
UT5270459-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist