=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396124236
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERCY PHARMACY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2015
-----------------------------------------------------
Last Update Date | 01/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1011 14TH AVE NW
-----------------------------------------------------
City | ARDMORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73401-1828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-220-6250
-----------------------------------------------------
Fax | 580-220-6251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14528 S OUTER 40 RD
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-5785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-628-5627
-----------------------------------------------------
Fax | 580-220-6251
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | DOUG MALCOLM
-----------------------------------------------------
Credential | PHARMD, MHA
-----------------------------------------------------
Telephone | 303-813-5532
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 12-7475
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------