Healthcare Provider Details

I. General information

NPI: 1053645986
Provider Name (Legal Business Name): MORTON DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E CAPITOL DR STE 1500
APPLETON WI
54911-8735
US

IV. Provider business mailing address

2500 E CAPITOL DR
APPLETON WI
54911-8735
US

V. Phone/Fax

Practice location:
  • Phone: 920-882-6333
  • Fax: 920-882-6633
Mailing address:
  • Phone: 920-882-6333
  • Fax: 920-882-6633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number8948-042
License Number StateWI

VIII. Authorized Official

Name: DAVID MORTON
Title or Position: V.P. OPERATIONS
Credential: RPH
Phone: 920-882-6333