Provider Demographics
NPI:1053645986
Name:MORTON DRUG CO INC
Entity Type:Organization
Organization Name:MORTON DRUG CO INC
Other - Org Name:MORTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:920-882-6333
Mailing Address - Street 1:2500 E CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8735
Mailing Address - Country:US
Mailing Address - Phone:920-882-6333
Mailing Address - Fax:920-882-6633
Practice Address - Street 1:2500 E CAPITOL DR STE 1500
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8735
Practice Address - Country:US
Practice Address - Phone:920-882-6333
Practice Address - Fax:920-882-6633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8948-042333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5131759OtherNCPDP PROVIDER IDENTIFICATION NUMBER
WI1053645986Medicaid
0195810017Medicare NSC