Provider Demographics
NPI:1780798751
Name:FAMILY ENTERPRISES INC
Entity type:Organization
Organization Name:FAMILY ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:573-686-1919
Mailing Address - Street 1:PO BOX 1187
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63902-1187
Mailing Address - Country:US
Mailing Address - Phone:573-686-1919
Mailing Address - Fax:573-686-8450
Practice Address - Street 1:449 S HWY 53
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-7204
Practice Address - Country:US
Practice Address - Phone:573-686-1919
Practice Address - Fax:573-686-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X, 332B00000X
MO0045253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2050727OtherPK
MO602198707Medicaid
MO602198707Medicaid