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Organization
MLM PHARMACY, INC.
Active
Organization
MLM PHARMACY, INC.
Active
Other names
MEDICINE SHOPPE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MORTON (OWNER)
(618) 548-0070
Entity
Organization
Contact information
Practice address
215 N BROADWAY AVE, SALEM, IL 62881-1511
(618) 548-0070
(618) 548-9846
Mailing address
215 N BROADWAY AVE, SALEM, IL 62881-1511
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
IL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
IL
332BX2000X
Oxygen Equipment & Supplies (DME)
—
IL
3336C0003X
Community/Retail Pharmacy
Primary
054014788
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1448530
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/03/2006
Last updated
03/07/2023
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