NPIMap

Medley Pharmacy Inc

Organization Active NPI Community/Retail Pharmacy · Rolla, MO

NPI 1740385608 · NPPES record last updated Sep 25, 2024

Key facts

NPI
1740385608
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
2005000322 (MO)
Legal business name
MEDLEY PHARMACY INC
Practice address
1100B S Bishop Ave
Rolla, MO 65401-4418
Phone
(573) 308-4899
Fax
(573) 308-4893
NPI assigned
Sep 14, 2006
Organization subpart
No

Authorized official

Name
Local Health Missouri Inc
Title
Owner
Phone
(573) 885-0885

Other NPIs on the same Medicare enrollment 18

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

Other NPIs with the same Medicare PAC ID 18

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

Corporate family (same tax ID) 40

Organizations that report the same tax identification number in the National Provider Directory.

View all 40

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MO

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070329000503 MO Part B Supplier - Mass Immunization (Roster Biller Only) 3577667682 18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Owensville, MO
O20100930052814 MO DME Supplier - Pharmacy 3577667682 Practice locations: Rolla, MO

National Provider Directory

Tax ID family
Sinks Pharmacy (41 organizations share this tax ID)

Locations

1024 S Bishop Ave
Rolla, MO 65401
Phone (573) 308-4899

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 2005000322 MO Yes
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

1100B S Bishop Ave
Rolla, MO 65401-4418

Mailing address

PO Box 528
Cuba, MO 65453-0528
Phone (573) 885-0885

Other identifiers

IdentifierTypeStateIssuer
604007401MedicaidMO
624007407MedicaidMO
2048269OtherPK

Other names

  • SINKS PHARMACY SOUTH Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 25, 2024.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727222400000",
    "number": "1740385608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 528",
            "city": "CUBA",
            "state": "MO",
            "postal_code": "654530528",
            "telephone_number": "573-885-0885",
            "fax_number": "573-677-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100B S BISHOP AVE",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "654014418",
            "telephone_number": "573-308-4899",
            "fax_number": "573-308-4893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLEY PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A",
        "authorized_official_last_name": "MISSOURI INC",
        "authorized_official_first_name": "LOCAL HEALTH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-885-0885"
    },
    "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": "2005000322",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "604007401",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "624007407",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2048269",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SINKS PHARMACY SOUTH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SINKS PHARMACY SOUTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rolla, MO

All providers in Rolla, MO · Community/Retail Pharmacy in Missouri

Sources for this page

Verify at the official NPI Registry.