Healthcare Provider Details

I. General information

NPI: 1013434851
Provider Name (Legal Business Name): MERCY PHARMACY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 W MOUNT VERNON ST STE 130
NIXA MO
65714-9613
US

IV. Provider business mailing address

1570 W BATTLEFIELD ST STE 110
SPRINGFIELD MO
65807-4163
US

V. Phone/Fax

Practice location:
  • Phone: 417-724-5340
  • Fax: 417-724-5354
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2017027475
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK JAEGER
Title or Position: VP AMBULATORY & SPECIAL PHARMACY
Credential:
Phone: 314-628-5607