Provider Demographics
NPI:1982747044
Name:MORGANS DRUG STORE INCORPORATED
Entity Type:Organization
Organization Name:MORGANS DRUG STORE INCORPORATED
Other - Org Name:MORGANS DRUG STORE HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:330-424-7287
Mailing Address - Street 1:118 E LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-1406
Mailing Address - Country:US
Mailing Address - Phone:330-424-7287
Mailing Address - Fax:330-424-3518
Practice Address - Street 1:118 E LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-1406
Practice Address - Country:US
Practice Address - Phone:330-424-7287
Practice Address - Fax:330-424-3518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OHRTP.020189000-033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6145504Medicaid
2074346OtherPK
2074346OtherPK