MEDICARE: FAMILY PHARMACY OF MISSOURI LLC

Medicare Provider Information

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	4079	MO

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2617302	OTHER	MO	NCPDP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1538134945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PHARMACY OF MISSOURI LLC

Provider Business Mailing Address
First Line	:	PO BOX 2403
Second Line	:
City	:	BRANSON WEST
State	:	MO
Zip	:	65737-2403
Country	:	US
Telephone Number	:	417-272-8966
Fax Number	:	417-272-8969

Provider Business Practice Location Address
First Line	:	18192 BUSINESS 13 STE A
Second Line	:
City	:	BRANSON WEST
State	:	MO
Zip	:	65737-8637
Country	:	US
Telephone Number	:	417-272-8966
Fax Number	:	417-272-8969

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

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	04/06/2017

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308