Provider Demographics
NPI:1588639991
Name:FAMILY PHARMACY OF STRAFFORD INC.
Entity Type:Organization
Organization Name:FAMILY PHARMACY OF STRAFFORD INC.
Other - Org Name:FAMILY PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-581-4335
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-0949
Mailing Address - Country:US
Mailing Address - Phone:417-736-2698
Mailing Address - Fax:417-736-2667
Practice Address - Street 1:307 E OLD ROUTE 66
Practice Address - Street 2:
Practice Address - City:STRAFFORD
Practice Address - State:MO
Practice Address - Zip Code:65757-7801
Practice Address - Country:US
Practice Address - Phone:417-736-2698
Practice Address - Fax:417-736-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
MO4894333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2615978OtherNCPDP
MO600058002Medicaid
MO620058008OtherMEDICAID DME
MO600058002Medicaid