Provider Demographics
NPI:1992406334
Name:MORRIS, MICKAYLN RENEE
Entity type:Individual
Prefix:
First Name:MICKAYLN
Middle Name:RENEE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICKAYLN
Other - Middle Name:RENEE
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15510 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3427
Mailing Address - Country:US
Mailing Address - Phone:760-948-1472
Mailing Address - Fax:760-948-2525
Practice Address - Street 1:15510 MAIN ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3427
Practice Address - Country:US
Practice Address - Phone:760-948-1472
Practice Address - Fax:760-948-2525
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1416939183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician