Provider Demographics
NPI:1255687398
Name:POWERS FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:POWERS FAMILY PHARMACY LLC
Other - Org Name:POWERS COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARLENE
Authorized Official - Middle Name:G
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:636-699-8031
Mailing Address - Street 1:7776 WINGHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-3601
Mailing Address - Country:US
Mailing Address - Phone:636-265-2924
Mailing Address - Fax:636-265-1306
Practice Address - Street 1:7776 WINGHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-3601
Practice Address - Country:US
Practice Address - Phone:636-265-2924
Practice Address - Fax:636-265-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-26
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120258033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6713370001Medicare NSC