MEDICARE: MORTON DRUG CO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336L0003X	Long Term Care Pharmacy
2	3336C0004X	Compounding Pharmacy
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy	7789	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5101059	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1811086598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORTON DRUG CO INC

Provider Business Mailing Address
First Line	:	PO BOX 778
Second Line	:
City	:	NEENAH
State	:	WI
Zip	:	54957-0778
Country	:	US
Telephone Number	:	920-727-3853
Fax Number	:	920-727-3867

Provider Business Practice Location Address
First Line	:	916 E MAIN ST
Second Line	:
City	:	WINNECONNE
State	:	WI
Zip	:	54986-9782
Country	:	US
Telephone Number	:	920-582-4414
Fax Number	:	920-582-7608

Authorized Official
Title or Position	:	VP CORPORATE SERVICES
Name	:	JEFFREY BLANK
Credential	:
Telephone Number	:	920-727-8882

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	09/08/2010

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Directions to “MORTON DRUG CO INC ” Practice Location

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