Provider Demographics
NPI:1528362480
Name:FAMILY PHARMACY OF MISSOURI LLC
Entity Type:Organization
Organization Name:FAMILY PHARMACY OF MISSOURI LLC
Other - Org Name:FAMILY PHARMACY #26
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-581-4335
Mailing Address - Street 1:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65673-0507
Mailing Address - Country:US
Mailing Address - Phone:417-334-5069
Mailing Address - Fax:417-334-5079
Practice Address - Street 1:225 CROSS CREEK BLVD STE A
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7520
Practice Address - Country:US
Practice Address - Phone:417-334-5069
Practice Address - Fax:417-334-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1528362480Medicaid
2639562OtherNCPDP PROVIDER IDENTIFICATION NUMBER
6045300012Medicare NSC