# FAMILY PHARMACY OF MOUNTAIN GROVE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851426852
- **Authorized official:** CHRISTINE MICHELLE COFFMAN (OWNER/PHARMACIST)
- **Authorized official phone:** (417) 926-4156

## Contact information

- **Practice address:** 1600 N MAIN ST, MOUNTAIN GROVE, MO 65711-1010
- **Practice address phone:** (417) 926-9655
- **Practice address fax:** (417) 926-0045
- **Mailing address:** 1600 N MAIN ST, MOUNTAIN GROVE, MO 65711-1010
- **Mailing address phone:** (417) 926-9655
- **Mailing address fax:** (417) 926-0045

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | — | — |
| 333600000X | Pharmacy | — | — | Yes |
| 3336C0003X | Community/Retail Pharmacy | 200059684 | MO | — |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 11/18/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 605201201 | — | MO |
| 05 | — | 625201207 | — | MO |