Healthcare Provider Details

I. General information

NPI: 1861134769
Provider Name (Legal Business Name): MEDLEY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 11/08/2024
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21748 US HIGHWAY 65
PRINCETON MO
64673
US

IV. Provider business mailing address

330 N. FRANKLIN PO BOX
CUBA MO
65453
US

V. Phone/Fax

Practice location:
  • Phone: 660-748-4048
  • Fax: 660-748-4044
Mailing address:
  • Phone: 573-885-0885
  • Fax: 573-677-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMY MITCHELL
Title or Position: PRESIDENT
Credential:
Phone: 573-885-0885