Provider Demographics
NPI:1780407015
Name:MEDLEY PHARMACY INC
Entity type:Organization
Organization Name:MEDLEY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSING/CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:573-885-0885
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-0528
Mailing Address - Country:US
Mailing Address - Phone:573-885-0885
Mailing Address - Fax:573-677-0567
Practice Address - Street 1:1903 E 9TH ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-2645
Practice Address - Country:US
Practice Address - Phone:660-359-5700
Practice Address - Fax:660-359-5701
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDLEY PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy