Provider Demographics
NPI:1619042041
Name:MORTON DRUG INC.
Entity Type:Organization
Organization Name:MORTON DRUG INC.
Other - Org Name:MORTON HILLTOP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-353-1147
Mailing Address - Street 1:1865 COLES BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2643
Mailing Address - Country:US
Mailing Address - Phone:740-353-1147
Mailing Address - Fax:740-353-6258
Practice Address - Street 1:1865 COLES BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2643
Practice Address - Country:US
Practice Address - Phone:740-353-1147
Practice Address - Fax:740-353-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-04644003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0626979Medicaid
OH0163470001Medicare NSC