Organization
FAMILY PHARMACY OF MISSOURI LLC
Active
Other names
FAMILY PHARMACY #28
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE TENNIS (DIRECTOR OF OPERATIONS)
(417) 581-4335
Entity
Organization
Contact information
Practice address
1494 STATE HIGHWAY 248 STE D, BRANSON, MO 65616-8160
(417) 334-8117
(417) 334-8150
Mailing address
1494 STATE HIGHWAY 248 STE D, BRANSON, MO 65616-8160
(417) 334-8117
(417) 334-8150
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2011029958
MO
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871875807
—
MO
01
—
2639839
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/15/2011
Last updated
01/24/2014
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