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Provider Information for 1699840033


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MORTON DRUG CO INC

Other Names:  
Doing Business As: 
MORTON LTC

Organization Subpart: NO

NPI: 1699840033
Last Updated: 2015-08-10
Certification Date:

Details

NameValue
NPI1699840033
Enumeration Date2006-11-21
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: JEFFREY BLANK
Title: VP CORPORATE SERVICES
Phone: 9207278882
Mailing Address PO BOX 778
NEENAH, WI 54957-0778
United States

Phone: 920-727-3853 | Fax:920-727-3867
 
Primary Practice Address 201 E BELL ST
NEENAH, WI 54956-5096
United States

Phone: 920-727-3853 | Fax:920-722-1530
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)2110942PK
MEDICAIDWI33290300
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 3336L0003X - Pharmacy - Long Term Care PharmacyWI9299-42