Healthcare Provider Details

I. General information

NPI: 1780754440
Provider Name (Legal Business Name): FAMILY HEALTH PHARMACIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GEORGIA ST
LOUISIANA MO
63353-1717
US

IV. Provider business mailing address

301 GEORGIA ST
LOUISIANA MO
63353-1717
US

V. Phone/Fax

Practice location:
  • Phone: 573-754-4551
  • Fax: 573-754-6934
Mailing address:
  • Phone: 573-754-4551
  • Fax: 573-754-6934

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2016042402
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHARI BLACK
Title or Position: PRESIDENT
Credential:
Phone: 573-754-4551