Healthcare Provider Details

I. General information

NPI: 1093058034
Provider Name (Legal Business Name): MEDLEY PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 HWY 17
IBERIA MO
65486-0000
US

IV. Provider business mailing address

PO BOX 528
OWENSVILLE MO
65066-0528
US

V. Phone/Fax

Practice location:
  • Phone: 573-793-2050
  • Fax: 573-793-2075
Mailing address:
  • Phone: 573-437-3440
  • Fax: 573-437-6909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateMO

VIII. Authorized Official

Name: LOCAL HEALTH MISSOURI INC
Title or Position: OWNER
Credential:
Phone: 573-885-0885