Healthcare Provider Details

I. General information

NPI: 1801076344
Provider Name (Legal Business Name): MORR FITZ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E MAIN ST
MORRISON IL
61270-2638
US

IV. Provider business mailing address

124 E MAIN ST
MORRISON IL
61270-2638
US

V. Phone/Fax

Practice location:
  • Phone: 815-772-3415
  • Fax: 815-772-7240
Mailing address:
  • Phone: 815-772-3415
  • Fax: 815-772-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. LUKE D VANDER BLEEK
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 815-772-3415