Healthcare Provider Details

I. General information

NPI: 1255241337
Provider Name (Legal Business Name): MORGAN JETTON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 BELLEVILLE CROSSING ST
BELLEVILLE IL
62226-3104
US

IV. Provider business mailing address

PO BOX 111
MAEYSTOWN IL
62256-0111
US

V. Phone/Fax

Practice location:
  • Phone: 618-310-1902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.308045
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: