Healthcare Provider Details

I. General information

NPI: 1326267915
Provider Name (Legal Business Name): MERRYFIELD PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W BENTON ST
WINDSOR MO
65360-1102
US

IV. Provider business mailing address

200 W BENTON ST
WINDSOR MO
65360-1102
US

V. Phone/Fax

Practice location:
  • Phone: 660-647-2134
  • Fax: 660-647-2653
Mailing address:
  • Phone: 660-647-2134
  • Fax: 660-647-2653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number002637
License Number StateMO

VIII. Authorized Official

Name: JIM MERRYFIELD
Title or Position: PHARMACIST
Credential:
Phone: 660-647-2134