Healthcare Provider Details

I. General information

NPI: 1336502855
Provider Name (Legal Business Name): FAMILY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1152 W JACKSON ST
OZARK MO
65721-9164
US

IV. Provider business mailing address

PO BOX 949
OZARK MO
65721-0949
US

V. Phone/Fax

Practice location:
  • Phone: 417-551-0374
  • Fax: 417-581-9263
Mailing address:
  • Phone: 417-551-0324
  • Fax: 417-268-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2014016571
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 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
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CARRIE TENNIS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 417-551-0324