Missouri LTC Pharmacy LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

2017040311 Issued in MO

Legal business name

MISSOURI LTC PHARMACY LLC

Doing business as

Infinium Pharmacy - Republic

Practice address

6129 W US Highway 60
Brookline, MO 65619-9441

Phone

(417) 708-5050

Fax

(417) 708-5055

NPI assigned

Oct 24, 2017

Last updated

Jun 5, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Janice S Ceriotti, RPHNPI 1255924163

Title

Chief Operating Officer

Phone

(314) 690-4500

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Infinium Pharmacy - Republic Doing business as

Medicare fee-for-service enrollment

Enrolled in MO2 enrollments

Enrollment records 2

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Missouri LTC Pharmacy LLC

  dba Infinium Pharmacy

  • Long Term Care Pharmacy
  • Fenton, MO
  • NPI 1134668445

  3476985060

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Missouri LTC Pharmacy LLC

  dba Infinium Pharmacy

  • Long Term Care Pharmacy
  • Fenton, MO
  • NPI 1134668445

  O20191120001785

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Hammons Avenue Operating LLC

  • Skilled Nursing Facility
  • Berryville, AR
  • NPI 1306547740

  Adp of the SNF

  CMS ownership
• Main Street Operating LLC

  • Skilled Nursing Facility
  • Van Buren, AR
  • NPI 1134820541

  Adp of the SNF

  CMS ownership

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Janice S Ceriotti

  • Pharmacist
  • Fenton, MO
  • NPI 1255924163
  NPD Authorized official
• Michelle Marie Caputa, BS, RPH, BCGP, MTM

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Brookline, MO
  • NPI 1376136382

  Geriatric

  NPD
• Andrew Caruso, DOCTOR OF PHARMACY

  • Pharmacist
  • Fenton, MO
  • NPI 1992398200
  NPD
• Nicholas Lee Farrar

  • Pharmacy Technician
  • Saint Louis, MO
  • NPI 1124329214
  NPD
• Alexandra Marie Fincher

  • Pharmacist
  • Fenton, MO
  • NPI 1598481624
  NPD
• Becky Fowkes

  • Pharmacist
  • Joplin, MO
  • NPI 1174818231
  NPD
• Lyndsay Fuller, PHARMD

  • Pharmacist
  • Brookline, MO
  • NPI 1679167563
  NPD
• Andrea Renee Halley

  • Licensed Practical Nurse
  • Brookline, MO
  • NPI 1134705569
  NPD
• Samantha Marie Hoffmann, PHARM.D.

  • Pharmacist
  • Monett, MO
  • NPI 1922660307
  NPD
• Kristie L Meacheam Wallace, RPH

  • Pharmacist
  • Ozark, MO
  • NPI 1093098063
  NPD
• Amanda Lynn Recchione, PHARM.D.

  • Pharmacist
  • Fenton, MO
  • NPI 1972197374
  NPD
• Paul Ruthman, PHARMD

  • Geriatric Pharmacist
  • Brookline, MO
  • NPI 1518552488
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780617600000",
    "number": "1003327537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6129 W US HIGHWAY 60",
            "city": "BROOKLINE",
            "state": "MO",
            "postal_code": "656199441",
            "telephone_number": "417-708-5050",
            "fax_number": "417-708-5055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6129 W US HIGHWAY 60",
            "city": "BROOKLINE",
            "state": "MO",
            "postal_code": "656199441",
            "telephone_number": "417-708-5050",
            "fax_number": "417-708-5055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOURI LTC PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-24",
        "last_updated": "2026-06-05",
        "certification_date": "2026-06-05",
        "status": "A",
        "authorized_official_last_name": "CERIOTTI",
        "authorized_official_first_name": "JANICE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "314-690-4500",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MO",
            "license": "2017040311",
            "primary": true
        },
        {
            "code": "1835G0303X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Geriatric",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "242178407",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600049471",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Infinium Pharmacy - Republic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrea Renee Halley
• Lester E Cox Medical Centers (CoxHealth Republic Clinic)
• Lester E Cox Medical Centers (Coxhealth Urgent Care Republic)
• Dalton Lusk
• Brady L Luttrell, M.D.
• Leann N Rensch, FNP-C
• Paul Ruthman, PHARMD
• Ashley Scroggins, PHARM.D.

• Long Term Care Pharmacy in Brookline, MO
• Providers in Brookline, MO by specialty
• Long Term Care Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.