Provider Demographics
NPI:1699740001
Name:FAMILY PHARMACY INC
Entity type:Organization
Organization Name:FAMILY PHARMACY INC
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:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MO
Mailing Address - Zip Code:65753-0469
Mailing Address - Country:US
Mailing Address - Phone:417-634-2060
Mailing Address - Fax:417-634-0168
Practice Address - Street 1:7154 STATE HIGHWAY 14 E
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MO
Practice Address - Zip Code:65753-8939
Practice Address - Country:US
Practice Address - Phone:417-634-2060
Practice Address - Fax:417-634-0168
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
MO6288333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO628941700Medicaid
MO2631314OtherNCPDP
MO608941704Medicaid
MO628941700OtherMEDICAID DME
MO608941704Medicaid
MO628941700OtherMEDICAID DME