MEDICARE: FAMILY PHARMACY OF MISSOURI LLC

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
2	3336L0003X	Long Term Care Pharmacy
3	333600000X	Pharmacy	2004026659	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2635677	OTHER	MO	NCPDP

General Provider Information

NPI Number	:	1447225412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PHARMACY OF MISSOURI LLC

Provider Business Mailing Address
First Line	:	PO BOX 1440
Second Line	:
City	:	NIXA
State	:	MO
Zip	:	65714-1440
Country	:	US
Telephone Number	:	417-724-2601
Fax Number	:	417-724-2621

Provider Business Practice Location Address
First Line	:	105 S RIDGECREST AVE
Second Line	:	SUITE 1 & 2
City	:	NIXA
State	:	MO
Zip	:	65714-7807
Country	:	US
Telephone Number	:	417-724-2601
Fax Number	:	417-724-2621

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	LYNN A MORRIS
Credential	:	R.PH.
Telephone Number	:	417-581-4335

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	04/06/2017

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Directions to “FAMILY PHARMACY OF MISSOURI LLC ” Practice Location

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