=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326267915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERRYFIELD PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2007
-----------------------------------------------------
Last Update Date | 04/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 W BENTON ST
-----------------------------------------------------
City | WINDSOR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65360-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-647-2134
-----------------------------------------------------
Fax | 660-647-2653
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 W BENTON ST
-----------------------------------------------------
City | WINDSOR
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65360-1102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-647-2134
-----------------------------------------------------
Fax | 660-647-2653
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | JIM MERRYFIELD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 660-647-2134
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 002637
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------