MEDICARE: LOCAL HEALTH SPECIALTY

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	3336C0003X	Community/Retail Pharmacy

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	:	1154893071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOCAL HEALTH SPECIALTY

Provider Business Mailing Address
First Line	:	330 N. FRANKLIN
Second Line	:	PO BOX 528
City	:	CUBA
State	:	MO
Zip	:	65453-6819
Country	:	US
Telephone Number	:	573-885-0885
Fax Number	:	573-677-0567

Provider Business Practice Location Address
First Line	:	522 N NEW BALLAS RD STE 206
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63141-6819
Country	:	US
Telephone Number	:	314-499-1227
Fax Number	:	314-499-1228

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN DONNELLY
Credential	:
Telephone Number	:	210-441-2036

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	12/12/2025

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