Provider Demographics
NPI:1154449825
Name:MYERS PHARMACY
Entity Type:Organization
Organization Name:MYERS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:417-778-7727
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:NORTH HIGHWAY 160
Mailing Address - City:ALTON
Mailing Address - State:MO
Mailing Address - Zip Code:65606-0307
Mailing Address - Country:US
Mailing Address - Phone:417-778-7727
Mailing Address - Fax:417-778-6820
Practice Address - Street 1:603 WEST HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:MO
Practice Address - Zip Code:65606-0307
Practice Address - Country:US
Practice Address - Phone:417-778-7727
Practice Address - Fax:417-778-6820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO851769505Medicaid