Provider Demographics
NPI:1639691959
Name:CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Entity Type:Organization
Organization Name:CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Other - Org Name:CMH SENIOR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-328-6258
Mailing Address - Street 1:1100 S SPRINGFIELD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-2512
Mailing Address - Country:US
Mailing Address - Phone:417-328-4700
Mailing Address - Fax:855-662-4032
Practice Address - Street 1:1100 S SPRINGFIELD AVE STE A
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613
Practice Address - Country:US
Practice Address - Phone:417-328-4700
Practice Address - Fax:855-662-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20170184313336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169941OtherPK