Provider Demographics
NPI:1518941509
Name:FAMILY HEALTH PHARMACIES INC
Entity Type:Organization
Organization Name:FAMILY HEALTH PHARMACIES INC
Other - Org Name:BOWLING GREEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:ELAYNE
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-754-4551
Mailing Address - Street 1:8 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-1534
Mailing Address - Country:US
Mailing Address - Phone:573-324-2112
Mailing Address - Fax:573-324-0048
Practice Address - Street 1:8 N COURT ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-1534
Practice Address - Country:US
Practice Address - Phone:573-324-2112
Practice Address - Fax:573-324-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MO20160424013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600446900Medicaid
2047964OtherPK
0246850001Medicare NSC