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Organization
MORTON ALWAN PHARMACY LLC
Active
Organization
MORTON ALWAN PHARMACY LLC
Active
Other names
Morton Alwan Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MINESINGER (OWNER/PHARMACIST)
(309) 676-6333
Entity
Organization
Contact information
Practice address
419 MAXINE DR, MORTON, IL 61550-2495
(309) 291-0180
(309) 291-0181
Mailing address
419 MAXINE DR, MORTON, IL 61550-2495
(309) 291-0180
(309) 291-0181
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054017911
IL
3336C0004X
Compounding Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135375
PK
—
Enumeration date
05/31/2012
Last updated
03/29/2016
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