Provider Demographics
NPI:1144295569
Name:FAMILY PHARMACY OF MISSOURI LLC
Entity type:Organization
Organization Name:FAMILY PHARMACY OF MISSOURI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-581-4335
Mailing Address - Street 1:759 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-2234
Mailing Address - Country:US
Mailing Address - Phone:417-859-5150
Mailing Address - Fax:417-859-5160
Practice Address - Street 1:759 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-2234
Practice Address - Country:US
Practice Address - Phone:417-859-5150
Practice Address - Fax:417-859-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
MO2005026016333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO606219103Medicaid
MO2636174OtherNCPDP
MO626219109OtherMEDICAID DME
MO606219103Medicaid
6045300007Medicare NSC