Provider Demographics
NPI:1558086561
Name:FOOD MERCHANTS, LLC
Entity Type:Organization
Organization Name:FOOD MERCHANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-773-1796
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-0397
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:704 S HIGHWAY 59 STE C
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831-8486
Practice Address - Country:US
Practice Address - Phone:417-845-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy