Healthcare Provider Details

I. General information

NPI: 1699292144
Provider Name (Legal Business Name): MERCY PHARMACY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W ELDON ST
SAINT JAMES MO
65559-1903
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 573-265-8901
  • Fax: 573-256-8310
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2017027481
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. PATRICK BERRY
Title or Position: EXEC-DIR RETAIL PHARMACY SVCS
Credential:
Phone: 314-628-5606