Healthcare Provider Details

I. General information

NPI: 1093706632
Provider Name (Legal Business Name): MEDLEY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 E HIGHWAY 32
SALEM MO
65560-2844
US

IV. Provider business mailing address

PO BOX 528
CUBA MO
65453
US

V. Phone/Fax

Practice location:
  • Phone: 573-729-4091
  • Fax: 573-729-2394
Mailing address:
  • Phone: 573-885-0885
  • Fax: 573-885-0882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number006425
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6425
License Number StateMO

VIII. Authorized Official

Name: LOCAL HEALTH MISSOURI INC
Title or Position: OWNER
Credential:
Phone: 573-885-0885