MEDICARE: FOOD MERCHANTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0004X	Compounding Pharmacy

General Provider Information

NPI Number	:	1427785278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOD MERCHANTS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 397
Second Line	:
City	:	NIXA
State	:	MO
Zip	:	65714-0397
Country	:	US
Telephone Number	:	417-719-4510
Fax Number	:	417-893-3908

Provider Business Practice Location Address
First Line	:	105 S RIDGECREST AVE STE 3A
Second Line	:
City	:	NIXA
State	:	MO
Zip	:	65714-6206
Country	:	US
Telephone Number	:	417-719-4510
Fax Number	:	417-893-3908

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	DONALD G SAVLEY
Credential	:
Telephone Number	:	417-818-3125

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	12/27/2024

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