Provider Demographics
NPI:1205143500
Name:MERRYFIELD, JAMES WILLIAM (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:MERRYFIELD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W BENTON ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:MO
Mailing Address - Zip Code:65360-1102
Mailing Address - Country:US
Mailing Address - Phone:660-647-2134
Mailing Address - Fax:660-647-2653
Practice Address - Street 1:200 W BENTON ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MO
Practice Address - Zip Code:65360-1102
Practice Address - Country:US
Practice Address - Phone:660-647-2134
Practice Address - Fax:660-647-2653
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 3336L0003X, 332B00000X, 333600000X, 3336C0003X
MO2005033289183500000X
MO029527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy