Organization
PRESCRIPTION DRUG STORE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHANE ALAN DUDLEY RPH (OWNER / PHARMACIST)
(573) 333-4890
Entity
Organization
Contact information
Practice address
410 WARD AVE, CARUTHERSVILLE, MO 63830
(573) 333-4890
(573) 333-0306
Mailing address
410 WARD AVE, CARUTHERSVILLE, MO 63830
(573) 333-4890
(573) 333-0306
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
000915
MO
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
600126106
—
MO
Enumeration date
06/18/2006
Last updated
01/28/2022
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