Healthcare Provider Details

I. General information

NPI: 1144295569
Provider Name (Legal Business Name): FAMILY PHARMACY OF MISSOURI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 W WASHINGTON ST
MARSHFIELD MO
65706-2234
US

IV. Provider business mailing address

759 W WASHINGTON ST
MARSHFIELD MO
65706-2234
US

V. Phone/Fax

Practice location:
  • Phone: 417-859-5150
  • Fax: 417-859-5160
Mailing address:
  • Phone: 417-859-5150
  • Fax: 417-859-5160

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 Number2005026016
License Number StateMO

VIII. Authorized Official

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