Morton Alwan Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054017911 Issued in IL

Legal business name

MORTON ALWAN PHARMACY LLC

Doing business as

Morton Alwan Pharmacy

Practice address

419 Maxine Dr
Morton, IL 61550-2495

Phone

(309) 291-0180

Fax

(309) 291-0181

NPI assigned

May 31, 2012

Organization subpart

No

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

Authorized official

Name

Michael Minesinger

Title

Owner/Pharmacist

Phone

(309) 676-6333

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Morton Alwan Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Tax ID family

Morton Alwan Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Morton Alwan Pharmacy LLC

  • Long Term Care Pharmacy
  • Morton, IL
  • NPI 1700613924
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Julianne Annette Manuel, RPH

  • Pharmacist
  • Mason City, IL
  • NPI 1467709386
  NPD (past)
• Sarah Trombetta

  • Pharmacist
  • Morton, IL
  • NPI 1073910949
  NPD (past)

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

{
    "created_epoch": "1338422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1114288628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 MAXINE DR",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615502495",
            "telephone_number": "309-291-0180",
            "fax_number": "309-291-0181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 MAXINE DR",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615502495",
            "telephone_number": "309-291-0180",
            "fax_number": "309-291-0181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORTON ALWAN PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-31",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "MINESINGER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "309-676-6333"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054017911",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135375",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Morton Alwan Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amber Miller
• Brittany Miller
• Victoria L Mitchell, LCSW
• Latrisha Mooberry, LCSW
• Courtney Leigh Morse
• Morton Alwan Pharmacy LLC
• Morton Audiology Inc
• Morton Community Unit Dist 709
• Morton Dental Center
• Morton Terrace Care Center, LLC

• Community/Retail Pharmacy in Morton, IL
• Providers in Morton, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; 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.