Organization
FAMILY PHARMACY INC.
Active
Other names
FAMILY PHARMACY #25
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE TENNIS (DIRECTOR OF OPERATIONS)
(417) 581-4335
Entity
Organization
Contact information
Practice address
916 N.W. 12TH AVE, SUITE F, AVA, MO 65608
(417) 683-1760
(417) 683-1768
Mailing address
PO BOX 326, AVA, MO 65608-0326
(417) 683-1760
(417) 683-1768
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2010031165
MO
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013224047
—
MO
01
—
2639257
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/13/2010
Last updated
01/24/2014
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