Healthcare Provider Details

I. General information

NPI: 1205143500
Provider Name (Legal Business Name): JAMES WILLIAM MERRYFIELD RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 08/27/2019
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 TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2005033289
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number029527
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: