Healthcare Provider Details

I. General information

NPI: 1659358356
Provider Name (Legal Business Name): FAMILY HEALTH PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W 1ST ST
STANBERRY MO
64489-1161
US

IV. Provider business mailing address

102 W 1ST ST
STANBERRY MO
64489-1161
US

V. Phone/Fax

Practice location:
  • Phone: 660-783-0700
  • Fax: 660-783-0500
Mailing address:
  • Phone: 660-783-0700
  • Fax: 660-783-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2005024201
License Number StateMO

VIII. Authorized Official

Name: MICHAEL GERALD MCQUINN
Title or Position: OWNER/PRESIDENT
Credential: B.S.
Phone: 660-783-0700