Healthcare Provider Details

I. General information

NPI: 1992438519
Provider Name (Legal Business Name): MT MORRIS PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S WESLEY AVE
MOUNT MORRIS IL
61054-1450
US

IV. Provider business mailing address

PO BOX 626
WARREN IL
61087-0626
US

V. Phone/Fax

Practice location:
  • Phone: 779-545-0159
  • Fax:
Mailing address:
  • Phone: 815-745-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KARRIE SABINSON
Title or Position: OWNER
Credential:
Phone: 815-745-3700