Provider Demographics
NPI:1346696572
Name:PREFERRED FAMILY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:PREFERRED FAMILY HEALTHCARE, INC.
Other - Org Name:BURRELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF REVENUE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CONOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-603-1460
Mailing Address - Street 1:3401 BERRYWOOD DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6515
Mailing Address - Country:US
Mailing Address - Phone:573-777-8430
Mailing Address - Fax:573-777-8431
Practice Address - Street 1:3401 BERRYWOOD DR
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6515
Practice Address - Country:US
Practice Address - Phone:573-777-8430
Practice Address - Fax:573-777-8431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X
MO20160141863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600032680Medicaid
MO2016014186OtherSTATE LICENSE