Healthcare Provider Details

I. General information

NPI: 1942352893
Provider Name (Legal Business Name): MICHAEL HERBERT MORTON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MAIN ST
BRANSON MO
65616-2713
US

IV. Provider business mailing address

700 VALLEY VIEW DR
BRANSON MO
65616-2370
US

V. Phone/Fax

Practice location:
  • Phone: 417-334-3187
  • Fax: 417-336-4939
Mailing address:
  • Phone: 417-334-7118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number040302
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: