Provider Demographics
NPI:1023616075
Name:MORRIS, JAKE A (PHARMD)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:A
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 1:2786 COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5031
Mailing Address - Country:US
Mailing Address - Phone:715-738-2418
Mailing Address - Fax:715-734-2425
Practice Address - Street 1:2786 COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5031
Practice Address - Country:US
Practice Address - Phone:715-738-2418
Practice Address - Fax:715-738-2425
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13649-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist