Provider Demographics
NPI:1669077541
Name:MORGAN, GINA MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:MORGAN
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 1:1101 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60481-1671
Mailing Address - Country:US
Mailing Address - Phone:815-476-2131
Mailing Address - Fax:815-476-2142
Practice Address - Street 1:1101 S WATER ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:IL
Practice Address - Zip Code:60481-1671
Practice Address - Country:US
Practice Address - Phone:815-476-2131
Practice Address - Fax:815-476-2142
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051295886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist