Provider Demographics
NPI:1376627638
Name:MORGAN DRUG STORE,INC.
Entity Type:Organization
Organization Name:MORGAN DRUG STORE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-337-3041
Mailing Address - Street 1:POBOX 69
Mailing Address - Street 2:123 SOUTH WALNUT ST.
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-0069
Mailing Address - Country:US
Mailing Address - Phone:606-337-3041
Mailing Address - Fax:606-337-0820
Practice Address - Street 1:123 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1619
Practice Address - Country:US
Practice Address - Phone:606-337-3041
Practice Address - Fax:606-337-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPO7032333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5400024500Medicaid
KY1808027Other3RD PARTY NABP NUMBER
KY5400024500Medicaid
KY1808027Other3RD PARTY NABP NUMBER