Healthcare Provider Details

I. General information

NPI: 1679601421
Provider Name (Legal Business Name): MEDLEY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 W MAIN
STEELVILLE MO
65565
US

IV. Provider business mailing address

PO BOX 528
CUBA MO
65453-0528
US

V. Phone/Fax

Practice location:
  • Phone: 573-775-2900
  • Fax: 573-775-3199
Mailing address:
  • Phone: 573-885-0885
  • Fax: 573-677-0567

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 Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2014014683
License Number StateMO

VIII. Authorized Official

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