Healthcare Provider Details

I. General information

NPI: 1720312911
Provider Name (Legal Business Name): FAMILY PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 PENNELL ST
CARL JUNCTION MO
64834-9478
US

IV. Provider business mailing address

1300 E, PENNELL ST.
CARL JUNCTION MO
64834
US

V. Phone/Fax

Practice location:
  • Phone: 417-649-7600
  • Fax: 417-649-7518
Mailing address:
  • Phone: 417-649-7600
  • Fax: 417-649-7518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARRIE D. TENNIS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 417-581-4335