Provider Demographics
NPI:1962708230
Name:MORRIS, MATTHEW DANE (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DANE
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 WILKESBORO HWY STE D
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8602
Mailing Address - Country:US
Mailing Address - Phone:704-872-7444
Mailing Address - Fax:
Practice Address - Street 1:1737 WILKESBORO HWY STE D
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-8602
Practice Address - Country:US
Practice Address - Phone:704-872-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist