Organization
RIDGE MAUD DRUG CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN MICHEL RPH MBA CDE (OWNER)
(573) 785-8218
Entity
Organization
Contact information
Practice address
910 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-4242
(573) 785-8218
(573) 785-8125
Mailing address
910 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-4242
(573) 785-8218
(573) 785-8125
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
002239
MO
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
002239
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2609519
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
600125603
—
MO
Enumeration date
11/03/2006
Last updated
07/24/2024
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