Individual
MR. SHANE A DUDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
410 WARD AVE, CARUTHERSVILLE, MO 63830-1451
(573) 333-4890
Mailing address
410 WARD AVE, CARUTHERSVILLE, MO 63830-1451
(573) 922-9199
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
043832
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600126106
—
MO
05
—
620126102
—
MO
Enumeration date
03/15/2007
Last updated
04/27/2021
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