Provider Demographics
NPI:1649389248
Name:MORTON PHARMACIES, INC.
Entity Type:Organization
Organization Name:MORTON PHARMACIES, INC.
Other - Org Name:MORTON'S DISCOUNT DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-258-0445
Mailing Address - Street 1:10 DEMPSEY LN
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2765
Mailing Address - Country:US
Mailing Address - Phone:606-528-2121
Mailing Address - Fax:606-258-0447
Practice Address - Street 1:10 DEMPSEY LN
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2765
Practice Address - Country:US
Practice Address - Phone:606-528-2121
Practice Address - Fax:606-258-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07008332B00000X, 333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54009394Medicaid
KY90011537Medicaid
KY9375401Medicare ID - Type UnspecifiedLOCAL PART B
KY90011537Medicaid