Provider Demographics
NPI:1598582421
Name:MARIONVILLE PHARMACY LLC
Entity type:Organization
Organization Name:MARIONVILLE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-258-2526
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:MARIONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65705-0217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 S HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:MARIONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65705-9407
Practice Address - Country:US
Practice Address - Phone:417-258-2526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy