=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205971132
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY HEALTH PHARMACIES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 03/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 GEORGIA ST
-----------------------------------------------------
City | LOUISIANA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63353-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-754-4551
-----------------------------------------------------
Fax | 573-754-6934
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 GEORGIA STREET
-----------------------------------------------------
City | LOUISIANA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-754-4551
-----------------------------------------------------
Fax | 573-754-6934
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. SHARI ELAYNE BLACK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 573-754-4551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 005350
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------