Provider Demographics
NPI:1093058034
Name:MEDLEY PHARMACY INC.
Entity Type:Organization
Organization Name:MEDLEY PHARMACY INC.
Other - Org Name:SINKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOCAL HEALTH
Authorized Official - Middle Name:
Authorized Official - Last Name:MISSOURI INC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-885-0885
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066-0528
Mailing Address - Country:US
Mailing Address - Phone:573-437-3440
Mailing Address - Fax:573-437-6909
Practice Address - Street 1:2322 HWY 17
Practice Address - Street 2:
Practice Address - City:IBERIA
Practice Address - State:MO
Practice Address - Zip Code:65486-0000
Practice Address - Country:US
Practice Address - Phone:573-793-2050
Practice Address - Fax:573-793-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600005037Medicaid
MO600005037Medicaid
MO0722170007Medicare NSC