NPIMap

Organization Active NPI

Sams Prescription Shop Inc

Doing business as Sam's Health Mart Pharmacy

  • Community/Retail Pharmacy
  • Moberly, MO
National Provider Identifier
1568453397
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
003205 Issued in MO
Legal business name
SAMS PRESCRIPTION SHOP INC
Doing business as
Sam's Health Mart Pharmacy
Practice address
300 N Morley St
Moberly, MO 65270-2334
Phone
(660) 263-0909
Fax
(660) 263-2124
NPI assigned
Nov 1, 2005
Last updated
Aug 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Authorized official

Name
Christian TadrusNPI 1932241536
Title
Owner
Phone
(660) 263-3309

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 003205 MO Primary
Specialty Pharmacy 3336S0011X
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

300 N Morley St
Moberly, MO 65270-2334

Mailing address

PO Box 957
(26-08872)
Moberly, MO 65270-0957
Phone (660) 263-3309

Other identifiers 2

IdentifierTypeStateIssuer
600061105MedicaidMO
2049295OtherPK

Other names 1

  • Sam's Health Mart Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110823000615 MO Part B Supplier - Mass Immunization (Roster Biller Only) 3971622234 2 other NPIs on this enrollment
Practice locations: Fayette, MO; Moberly, MO

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1130803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1568453397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 957",
            "address_2": "(26-08872)",
            "city": "MOBERLY",
            "state": "MO",
            "postal_code": "652700957",
            "telephone_number": "660-263-3309",
            "fax_number": "660-263-3514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N MORLEY ST",
            "city": "MOBERLY",
            "state": "MO",
            "postal_code": "652702334",
            "telephone_number": "660-263-0909",
            "fax_number": "660-263-2124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMS PRESCRIPTION SHOP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-01",
        "last_updated": "2022-08-24",
        "certification_date": "2021-08-12",
        "status": "A",
        "authorized_official_last_name": "TADRUS",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "660-263-3309"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "003205",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600061105",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2049295",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sam's Health Mart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sam's Health Mart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moberly, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.