Provider Demographics
NPI:1417922832
Name:FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:FAMILY PHARMACY INC
Other - Org Name:FAMILY PHARMACY #18
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-581-4335
Mailing Address - Street 1:3202 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4037
Mailing Address - Country:US
Mailing Address - Phone:417-623-3800
Mailing Address - Fax:417-623-1113
Practice Address - Street 1:3202 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4037
Practice Address - Country:US
Practice Address - Phone:417-623-3800
Practice Address - Fax:417-623-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
MO2005017363333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2629282OtherNCPDP
MO620399808OtherMEDICAID DME
MO620399808Medicaid
MO600399802Medicaid
MO620399808Medicaid