Healthcare Provider Details

I. General information

NPI: 1407245012
Provider Name (Legal Business Name): CHILLICOTHE FAMILY PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 S WASHINGTON ST
CHILLICOTHEE MO
64601-3038
US

IV. Provider business mailing address

504 S WASHINGTON ST
CHILLICOTHEE MO
64601-3038
US

V. Phone/Fax

Practice location:
  • Phone: 660-240-0828
  • Fax: 660-070-0019
Mailing address:
  • Phone: 660-240-0828
  • Fax: 660-070-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2015012618
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2015012618
License Number StateMO

VIII. Authorized Official

Name: DR. SCOTT A CADY
Title or Position: PIC/ CO-OWNER
Credential: PHARMD
Phone: 660-240-0828