Provider Demographics
NPI:1568598852
Name:MORTON, MICHAEL L (R PH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:MORTON
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 ASHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2830
Mailing Address - Country:US
Mailing Address - Phone:606-528-2736
Mailing Address - Fax:606-258-0447
Practice Address - Street 1:200 W GORDON ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-1550
Practice Address - Country:US
Practice Address - Phone:606-528-9305
Practice Address - Fax:606-528-9306
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist