NPIMap

Medley Pharmacy Inc

Organization Active NPI Community/Retail Pharmacy · Rolla, MO

NPI 1972607935 · NPPES record last updated Jan 13, 2023

Key facts

NPI
1972607935
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
2005000323 (MO)
Legal business name
MEDLEY PHARMACY INC
Practice address
1375 E 10TH St Ste B
Rolla, MO 65401-3591
Phone
(573) 364-9616
Fax
(573) 341-3986
NPI assigned
Sep 12, 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
O20100930046317 MO DME Supplier - Pharmacy
DME Supplier - Medical Supply Company With Registered Pharmacist		 3577667682 Practice locations: Rolla, MO

National Provider Directory

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 2005000323 MO Yes
Compounding Pharmacy 3336C0004X
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

1375 E 10TH St Ste B
Rolla, MO 65401-3591

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
623143005MedicaidMO
603143009MedicaidMO
2051461OtherPK

Other names

  • SINKS PHARMACY 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.