Provider Demographics
NPI:1235125741
Name:MORTON HEALTH CENTER PHARMACY
Entity Type:Organization
Organization Name:MORTON HEALTH CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAUNYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-295-6107
Mailing Address - Street 1:1334 N LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-5907
Mailing Address - Country:US
Mailing Address - Phone:918-295-6130
Mailing Address - Fax:918-295-6199
Practice Address - Street 1:1334 N LANSING AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-5907
Practice Address - Country:US
Practice Address - Phone:918-295-6130
Practice Address - Fax:918-295-6199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORTON COMPREHENSIVE HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-21
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22681333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK90003910072OtherMEDICAID
OK100234720AMedicaid
OKWCDPGOtherMEDICARE
OK100768880JOtherMEDICAID
OK90003910072OtherMEDICAID
OK371803OtherMEDICARE