Provider Demographics
NPI:1578062113
Name:MORR FITZ INC
Entity Type:Organization
Organization Name:MORR FITZ INC
Other - Org Name:FITZGERALD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDER BLEEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-772-3415
Mailing Address - Street 1:124 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:IL
Mailing Address - Zip Code:61270-2638
Mailing Address - Country:US
Mailing Address - Phone:815-772-3415
Mailing Address - Fax:815-772-7240
Practice Address - Street 1:124 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:IL
Practice Address - Zip Code:61270-2638
Practice Address - Country:US
Practice Address - Phone:815-772-3415
Practice Address - Fax:815-772-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL310400000X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-001Medicaid