NPIMap

Organization Active NPI

Medley Pharmacy Inc

Doing business as EverCare Pharmacy LTC

  • Community/Retail Pharmacy
  • Princeton, MO
National Provider Identifier
1861134769
Registry record updated Nov 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MEDLEY PHARMACY INC
Doing business as
EverCare Pharmacy LTC
Practice address
21748 US Highway 65
Princeton, MO 64673
Phone
(660) 748-4048
Fax
(660) 748-4044
NPI assigned
Apr 11, 2022
Last updated
Nov 8, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDLEY PHARMACY, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2024

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

Authorized official

Name
Mrs. Amy Mitchell
Title
President
Phone
(573) 885-0885

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary
Long Term Care Pharmacy 3336L0003X NU
Compounding Pharmacy 3336C0004X NU

Addresses

Primary practice location

21748 US Highway 65
Princeton, MO 64673

Mailing address

330 N. Franklin
PO Box
Cuba, MO 65453
Phone (573) 885-0885

Other identifiers 3

IdentifierTypeStateIssuer
2019013879OtherMOSTATE PHARMACY LICENSE
2500053848OtherMOSTATE CONTROLLED SUBSTANCE BNDD
600068902MedicaidMO

Other names 1

  • EverCare Pharmacy LTC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Sinks Pharmacy 10041 organizations share this tax ID, including this one
Part of
Sinks Pharmacy 100

Other organizations with this tax ID 40

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

View all 40

Locations

330 N Franklin St
Cuba, MO 65453
Phone (573) 885-0885

Practitioners & affiliated clinicians

Practitioners 3

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": "1649635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731024000000",
    "number": "1861134769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 N. FRANKLIN",
            "address_2": "PO BOX",
            "city": "CUBA",
            "state": "MO",
            "postal_code": "65453",
            "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": "21748 US HIGHWAY 65",
            "city": "PRINCETON",
            "state": "MO",
            "postal_code": "64673",
            "telephone_number": "660-748-4048",
            "fax_number": "660-748-4044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDLEY PHARMACY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDLEY PHARMACY, INC.",
        "enumeration_date": "2022-04-11",
        "last_updated": "2024-11-08",
        "certification_date": "2022-03-25",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-885-0885",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PHARMACY LICENSE",
            "identifier": "2019013879",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE CONTROLLED SUBSTANCE BNDD",
            "identifier": "2500053848",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600068902",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EverCare Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Princeton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.