Provider Demographics
NPI:1427167683
Name:MERRYFIELD PHARMACY INC.
Entity type:Organization
Organization Name:MERRYFIELD PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:MERRYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:660-647-2134
Mailing Address - Street 1:200 W BENTON ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:MO
Mailing Address - Zip Code:65360-1354
Mailing Address - Country:US
Mailing Address - Phone:660-647-2134
Mailing Address - Fax:660-647-2653
Practice Address - Street 1:200 W BENTON ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MO
Practice Address - Zip Code:65360-1102
Practice Address - Country:US
Practice Address - Phone:660-647-2134
Practice Address - Fax:660-647-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336L0003X
MO0026373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2612720OtherNCPDP
MO600279103Medicaid
0556320001Medicare NSC