Marshfield Clinic Pharmacy LLC
Organization Active NPI Community/Retail Pharmacy · Marshfield, MO
NPI 1598879561 · NPPES record last updated Jun 11, 2021
Key facts
- NPI
- 1598879561
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 2004036065 (MO)
- Legal business name
- MARSHFIELD CLINIC PHARMACY LLC
- Practice address
- 483 Pomme de Terre
Marshfield, MO 65706-2386 - Phone
- (417) 468-4442
- Fax
- (417) 468-4462
- NPI assigned
- Aug 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Michael Vinehout, RPH
- Title
- Managing Member
- Phone
- (417) 468-4442
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210928003115 | MO | Part B Supplier - Independent Clinical Laboratory | 7214147792 | Practice locations: Marshfield, MO |
National Provider Directory
- Tax ID family
- Marshfield Clinic Pharmacy LLC
Locations
483 Pomme de Terre
Marshfield, MO 65706
Phone (417) 468-4442
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 2004036065 | MO | Yes |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
483 Pomme de Terre
Marshfield, MO 65706-2386
Mailing address
483 Pomme de Terre
Marshfield, MO 65706-2386
Phone (417) 468-4442
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2629117 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER | |
| 626937908 | Medicaid | MO | |
| 606937902 | Medicaid | MO |
Other names
- MARSHFIELD CLINIC PHARMACY LLC
Other providers in Marshfield, MO
- Lester E Cox Medical Centers
- Sarah Lewis
- Cassaundra Lowe
- Marshfield Clinic Pharmacy LLC
- Marshfield Clinic Pharmacy LLC
- Marshfield Clinic Pharmacy, LLC
- Marshfield Healthcare LLC
- Marshfield Opco, LLC
- Marshfield Operations Management LLC
- Marshfield Place LLC
All providers in Marshfield, MO · Community/Retail Pharmacy in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.