Organization
PRESCRIPTION DRUG STORE
Active
Parent organization
JERRY KELLY DUDLEY
Other names
Prescription Drug Store #2
Organization subpart
Yes
Provider details
NPI number
Legal business name
JERRY KELLY DUDLEY
Authorized official
SHANE DUDLEY (OWNER/PHARMACIST)
(573) 359-0009
Entity
Organization
Contact information
Practice address
308 E MAIN ST, HAYTI, MO 63851-1639
(573) 359-0008
(573) 359-6376
Mailing address
308 E MAIN ST, HAYTI, MO 63851-1639
(573) 359-0008
(573) 359-6376
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
004067
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600126114
—
MO
Enumeration date
06/21/2006
Last updated
03/24/2021
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