Provider Demographics
NPI:1407245012
Name:CHILLICOTHE FAMILY PHARMACY, LLC
Entity Type:Organization
Organization Name:CHILLICOTHE FAMILY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC/ CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CADY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:660-240-0828
Mailing Address - Street 1:504 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:MO
Mailing Address - Zip Code:64601-3038
Mailing Address - Country:US
Mailing Address - Phone:660-240-0828
Mailing Address - Fax:660-070-0019
Practice Address - Street 1:504 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-3038
Practice Address - Country:US
Practice Address - Phone:660-240-0828
Practice Address - Fax:660-070-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WD0400X
MO2015012618332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600021831Medicaid
MO7408520001Medicare NSC