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Organization

PRESCRIPTION DRUG STORE

Active
Parent organization
PRESCRIPTION DRUG STORE LLC
Other names
Prescription Drug Store
Organization subpart
Yes

Provider details

NPI number
Legal business name
PRESCRIPTION DRUG STORE LLC
Authorized official
SHANE A DUDLEY (OWNER)
(573) 333-4890
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
332B00000X
Durable Medical Equipment & Medical Supplies
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
620126110
MO
Enumeration date
10/28/2008
Last updated
04/09/2021
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