Provider Demographics
NPI:1245746072
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:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-0528
Mailing Address - Country:US
Mailing Address - Phone:573-885-0885
Mailing Address - Fax:573-677-0567
Practice Address - Street 1:124 OLD HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:BOURBON
Practice Address - State:MO
Practice Address - Zip Code:65441-6544
Practice Address - Country:US
Practice Address - Phone:573-885-0885
Practice Address - Fax:573-885-0885
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDLEY PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-15
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy