Healthcare Provider Details

I. General information

NPI: 1558086561
Provider Name (Legal Business Name): FOOD MERCHANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 09/06/2023
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S HIGHWAY 59 STE C
ANDERSON MO
64831-8486
US

IV. Provider business mailing address

PO BOX 397
NIXA MO
65714-0397
US

V. Phone/Fax

Practice location:
  • Phone: 417-845-7799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERICA LYNN MAHN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 417-773-1796