MEDICARE: MERCY PHARMACY SERVICES, 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	183500000X	Pharmacist
2	333600000X	Pharmacy	2017027481	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2627074	OTHER	MO	NCPDP#
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699292144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY PHARMACY SERVICES, LLC

Provider Business Mailing Address
First Line	:	1570 W BATTLEFIELD ST STE 110
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-4163
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 W ELDON ST
Second Line	:
City	:	SAINT JAMES
State	:	MO
Zip	:	65559-1903
Country	:	US
Telephone Number	:	573-265-8901
Fax Number	:	573-256-8310

Authorized Official
Title or Position	:	EXEC-DIR RETAIL PHARMACY SVCS
Name	:	MR. PATRICK BERRY
Credential	:
Telephone Number	:	314-628-5606

Provider Enumeration Date	:	08/25/2017
Last Update Date	:	08/25/2017

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Directions to “MERCY PHARMACY SERVICES, LLC ” Practice Location

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