Healthcare Provider Details

I. General information

NPI: 1568202950
Provider Name (Legal Business Name): MEDLEY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
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
65453-0528
US

V. Phone/Fax

Practice location:
  • Phone: 573-729-4091
  • Fax: 573-429-2394
Mailing address:
  • Phone: 573-885-0885
  • Fax: 573-677-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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