Provider Demographics
NPI:1326267915
Name:MERRYFIELD PHARMACY INC.
Entity Type:Organization
Organization Name:MERRYFIELD PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-647-2134
Mailing Address - Street 1:200 W BENTON ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:MO
Mailing Address - Zip Code:65360-1102
Mailing Address - Country:US
Mailing Address - Phone:660-647-2134
Mailing Address - Fax:660-647-2653
Practice Address - Street 1:200 W BENTON ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MO
Practice Address - Zip Code:65360-1102
Practice Address - Country:US
Practice Address - Phone:660-647-2134
Practice Address - Fax:660-647-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002637333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0556320001Medicare NSC