Provider Demographics
NPI:1659358356
Name:FAMILY HEALTH PHARMACY, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH PHARMACY, INC.
Other - Org Name:FAMILY HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:MCQUINN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:660-783-0700
Mailing Address - Street 1:102 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:STANBERRY
Mailing Address - State:MO
Mailing Address - Zip Code:64489-1161
Mailing Address - Country:US
Mailing Address - Phone:660-783-0700
Mailing Address - Fax:660-783-0500
Practice Address - Street 1:102 W 1ST ST
Practice Address - Street 2:
Practice Address - City:STANBERRY
Practice Address - State:MO
Practice Address - Zip Code:64489-1161
Practice Address - Country:US
Practice Address - Phone:660-783-0700
Practice Address - Fax:660-783-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
MO2005024201333600000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2049122OtherPK
MO606215507Medicaid
MO606215507Medicaid