Healthcare Provider Details

I. General information

NPI: 1255972196
Provider Name (Legal Business Name): FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 N STURGEON ST
MONTGOMERY CITY MO
63361-1426
US

IV. Provider business mailing address

806 N STURGEON ST
MONTGOMERY CITY MO
63361-1426
US

V. Phone/Fax

Practice location:
  • Phone: 573-564-2231
  • Fax: 573-564-5249
Mailing address:
  • Phone: 573-564-2231
  • Fax: 573-564-5249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN HOLTMAN
Title or Position: PAARTNER
Credential:
Phone: 573-564-2273