Healthcare Provider Details

I. General information

NPI: 1225287485
Provider Name (Legal Business Name): MORTON DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 JACKSON ST
OSHKOSH WI
54901-4713
US

IV. Provider business mailing address

PO BOX 778
NEENAH WI
54957-0778
US

V. Phone/Fax

Practice location:
  • Phone: 920-651-4236
  • Fax: 920-651-0971
Mailing address:
  • Phone: 920-727-3853
  • Fax: 920-727-3867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number900842
License Number StateWI

VIII. Authorized Official

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