NPIMap

Organization Active NPI

Morton Drug Co Inc

Doing business as Morton Pharmacy

  • Community/Retail Pharmacy
  • Oshkosh, WI
National Provider Identifier
1104916220
Registry record updated Sep 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
7995-42 Issued in WI
Legal business name
MORTON DRUG CO INC
Doing business as
Morton Pharmacy
Practice address
1855 S Koeller St
Oshkosh, WI 54902-6214
Phone
(920) 223-7390
Fax
(920) 223-7394
NPI assigned
Oct 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey Blank
Title
VP Corporate Services
Phone
(920) 727-8882

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 7995-42 WI Primary

Addresses

Primary practice location

1855 S Koeller St
Oshkosh, WI 54902-6214

Mailing address

PO Box 778
Neenah, WI 54957-0778
Phone (920) 727-3853

Other identifiers 2

IdentifierTypeStateIssuer
33248700MedicaidWI
5121986OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • MORTON PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090528000558 WI Part B Supplier - Mass Immunization (Roster Biller Only) 7113076860 12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Neenah, WI

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1855 S Koeller St
Ste 242
Oshkosh, WI 54902
Phone (920) 426-7110

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283904000000",
    "number": "1104916220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 778",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549570778",
            "telephone_number": "920-727-3853",
            "fax_number": "920-727-3867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 S KOELLER ST",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549026214",
            "telephone_number": "920-223-7390",
            "fax_number": "920-223-7394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORTON DRUG CO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2010-09-08",
        "status": "A",
        "authorized_official_last_name": "BLANK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "VP CORPORATE SERVICES",
        "authorized_official_telephone_number": "920-727-8882"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "7995-42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33248700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5121986",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MORTON PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oshkosh, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.