MEDICARE: MEDLEY PHARMACY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		MO
2	3336C0003X	Community/Retail Pharmacy		MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093058034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDLEY PHARMACY INC.

Provider Business Mailing Address
First Line	:	PO BOX 528
Second Line	:
City	:	OWENSVILLE
State	:	MO
Zip	:	65066-0528
Country	:	US
Telephone Number	:	573-437-3440
Fax Number	:	573-437-6909

Provider Business Practice Location Address
First Line	:	2322 HWY 17
Second Line	:
City	:	IBERIA
State	:	MO
Zip	:	65486-0000
Country	:	US
Telephone Number	:	573-793-2050
Fax Number	:	573-793-2075

Authorized Official
Title or Position	:	OWNER
Name	:	LOCAL HEALTH MISSOURI INC
Credential	:
Telephone Number	:	573-885-0885

Provider Enumeration Date	:	03/28/2013
Last Update Date	:	09/12/2022

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Directions to “MEDLEY PHARMACY INC. ” Practice Location

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