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	2004031235	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	2635766	OTHER	MO	NCPDP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881669208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PHARMACY OF MISSOURI LLC

Provider Business Mailing Address
First Line	:	PO BOX 244
Second Line	:
City	:	FAIR GROVE
State	:	MO
Zip	:	65648-0244
Country	:	US
Telephone Number	:	417-759-6300
Fax Number	:	417-759-6305

Provider Business Practice Location Address
First Line	:	49 E OLD MILL RD
Second Line	:
City	:	FAIR GROVE
State	:	MO
Zip	:	65648-8452
Country	:	US
Telephone Number	:	417-759-6300
Fax Number	:	417-759-6305

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LYNN A MORRIS
Credential	:	R.PH.
Telephone Number	:	417-759-6300

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

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Directions to “FAMILY PHARMACY OF MISSOURI LLC ” Practice Location

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