Provider Demographics
NPI:1194767970
Name:FOOD MERCHANTS LLC
Entity type:Organization
Organization Name:FOOD MERCHANTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:SAVLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-818-3125
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-0397
Mailing Address - Country:US
Mailing Address - Phone:417-818-3125
Mailing Address - Fax:417-374-7582
Practice Address - Street 1:2650 W KEARNEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-2037
Practice Address - Country:US
Practice Address - Phone:417-865-1547
Practice Address - Fax:417-862-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X, 3336S0011X
MO20030317783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2048970OtherPK
MO606075505Medicaid
MO626075501Medicaid
MO606075505Medicaid