Healthcare Provider Details

I. General information

NPI: 1598879561
Provider Name (Legal Business Name): MARSHFIELD CLINIC PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 POMME DE TERRE
MARSHFIELD MO
65706-2386
US

IV. Provider business mailing address

483 POMME DE TERRE
MARSHFIELD MO
65706-2386
US

V. Phone/Fax

Practice location:
  • Phone: 417-468-4442
  • Fax: 417-468-4462
Mailing address:
  • Phone: 417-468-4442
  • Fax: 417-468-4462

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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2004036065
License Number StateMO

VIII. Authorized Official

Name: MICHAEL VINEHOUT
Title or Position: MANAGING MEMBER
Credential: RPH
Phone: 417-468-4442