# FAMILY PHARMACY OF MISSOURI LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Family Pharmacy \#12
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144295015
- **Authorized official:** LYNN A MORRIS (OWNER/PRESIDENT)
- **Authorized official phone:** (417) 581-4335

## Contact information

- **Practice address:** 14974 STATE HWY 160, FORSYTH, MO 65653
- **Practice address phone:** (417) 546-8200
- **Practice address fax:** (417) 546-8207
- **Mailing address:** PO BOX 1175, FORSYTH, MO 65653-1175
- **Mailing address phone:** (417) 546-8200
- **Mailing address fax:** (417) 546-8207

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | — | — |
| 333600000X | Pharmacy | 2004008738 | MO | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | — | — |

## Other

- **Enumeration date:** 02/22/2006
- **Last updated:** 04/06/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2635475 | NCPDP | MO |
| 05 | — | 606141604 | — | MO |
| 01 | — | 626141600 | MEDICAID DME | MO |
| 05 | — | 626141600 | — | MO |