Healthcare Provider Details

I. General information

NPI: 1275622953
Provider Name (Legal Business Name): MORTON DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 RACINE ST
MENASHA WI
54952-2337
US

IV. Provider business mailing address

PO BOX 778
NEENAH WI
54957-0778
US

V. Phone/Fax

Practice location:
  • Phone: 920-727-3846
  • Fax: 920-727-3870
Mailing address:
  • Phone: 920-727-3853
  • Fax: 920-727-3867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8129
License Number StateWI

VIII. Authorized Official

Name: JEFFREY BLANK
Title or Position: VP CORPORATE SERVICES
Credential:
Phone: 920-727-8882