Healthcare Provider Details

I. General information

NPI: 1144295015
Provider Name (Legal Business Name): FAMILY PHARMACY OF MISSOURI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14974 STATE HWY 160
FORSYTH MO
65653
US

IV. Provider business mailing address

PO BOX 1175
FORSYTH MO
65653-1175
US

V. Phone/Fax

Practice location:
  • Phone: 417-546-8200
  • Fax: 417-546-8207
Mailing address:
  • Phone: 417-546-8200
  • Fax: 417-546-8207

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 Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2004008738
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier626141600
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerMEDICAID DME
# 2
Identifier626141600
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 3
Identifier606141604
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 4
Identifier2635475
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerNCPDP

VIII. Authorized Official

Name: LYNN A MORRIS
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 417-581-4335