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Contact Information

PRESCRIPTION DRUG STORE LLC
410 WARD AVE
CARUTHERSVILLE, MO63830
 Phone: 573-333-4890
 Fax: 573-333-0306
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for PRESCRIPTION DRUG STORE LLC

NPI # 1497790968
LBN Legal business name PRESCRIPTION DRUG STORE LLC
Authorized official SHANE DUDLEY - (OWNER / PHARMACIST)
Entity Organization
Organization subpart 1 No
Enumeration date 06/18/2006
Last updated 01/28/2022 - About 4 years ago
Identifiers
MO License # 000915
MO Medicaid 600126106
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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