MR. SHANE A DUDLEY (NPI# 1154455673) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154455673 |
| Entity Type | Individual |
| Full Name | MR. SHANE A DUDLEY |
| Credential | R.PH. |
| Practice Address |
410 Ward Ave Caruthersville MO 63830-1451 |
| Practice Telephone | 5733334890 |
| Mailing Telephone | 5739229199 |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2018-03-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 043832 | MO | Pharmacy Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 620126102 | 05 | |
| MO | 600126106 | 05 |
| Street Address |
410 WARD AVE |
| City | CARUTHERSVILLE |
| State | MO |
| Zip Code | 63830-1451 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497790968 | Prescription Drug Store LLC | Pharmacy | 410 Ward Ave, Caruthersville, MO 63830 | 2006-06-18 |
| 1902247869 | Dax Owen Melugin | Pharmacist | 410 Ward Ave, Caruthersville, MO 63830-1451 | 2013-07-08 |
| 1952554693 | Prescription Drug Store LLC | Durable Medical Equipment & Medical Supplies | 410 Ward Ave, Caruthersville, MO 63830-1451 | 2008-10-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689216400 | Jazmyne S Hall | Behavior Technician | 915 Highway 84, Caruthersville, MO 63830 | 2019-10-14 |
| 1134573017 | Nathan Straeter | Pharmacist | State Highway 84 West, Caruthersville, MO 63830 | 2016-04-18 |
| 1861805624 | Ashley Marie Ballard | Case Manager/Care Coordinator | 10 & Ward Suite C, Caruthersville, MO 63830 | 2014-06-09 |
| 1356764435 | Jena Payne | Case Manager/Care Coordinator | 10th Ward St, Caruthersville, MO 63830 | 2014-01-27 |
| 1619390705 | James Smith | Case Manager/Care Coordinator | 10th & Ward Suite B, Caruthersville, MO 63830 | 2014-01-27 |
| 1730501370 | Belinda Fields | Community Health Worker | 10th & Ward, C, Caruthersville, MO 63830 | 2014-01-16 |
| 1831387372 | T M Swinger & D V Mckillip, Ptr | Optometrist | 101 E. 10th St., Suite A, Caruthersville, MO 63830 | 2007-10-10 |
| 1437284635 | Terrence M Swinger | Optometrist | 101 E. Tenth St., Suite A, Caruthersville, MO 63830 | 2007-02-21 |
| 1114097581 | John D Gardner | Dentist | 1210 Ward Ave, Caruthersville, MO 63830 | 2006-11-09 |
| 1366512287 | Krilurk Chanvitayapongs | Pharmacist | 2709 South Ward, Caruthersville, MO 63830 | 2006-11-08 |
| Find all providers in zip 63830 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134573017 | Nathan Straeter | Pharmacist | State Highway 84 West, Caruthersville, MO 63830 | 2016-04-18 |
| 1366512287 | Krilurk Chanvitayapongs | Pharmacist | 2709 South Ward, Caruthersville, MO 63830 | 2006-11-08 |
| 1639523509 | John Priggel | Pharmacist | State Highway 84 West, Caruthersville, MO 63830 | 2016-04-18 |
| 1902247869 | Dax Owen Melugin | Pharmacist | 410 Ward Ave, Caruthersville, MO 63830-1451 | 2013-07-08 |
| 1003112095 | James R Brands | Pharmacist | 1200 Ward Ave, Caruthersville, MO 63830-2204 | 2011-02-08 |
| 1447329594 | Henry Thomas Hayden | Pharmacist | 1200 Ward Ave, Caruthersville, MO 63830-2204 | 2006-11-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952902777 | Kimberly Rachelle Troha | Pharmacist | 605 S Jewel Ct, Nixa, MO 65714-7590 | 2020-11-06 |
| 1225639065 | Kimberly Frederich | Pharmacist | 6149 N Mattox Rd, Kansas City, MO 64151-2579 | 2020-11-06 |
| 1386245108 | Stephanie Mummert | Pharmacist | 404 Nw Highcliffe Dr, Lees Summit, MO 64081-2061 | 2020-11-06 |
| 1023619038 | William Molenaar | Pharmacist | 18401 State Hwy 13, Branson West, MO 65737 | 2020-11-05 |
| 1235730243 | Jeffery William Ellis | Pharmacist | 1571 Wentzville Parkway, Wentzville, MO 63385 | 2020-11-05 |
| 1457952624 | Brian Gregory Young | Pharmacist | 185 St.robert Blvd, St. Robert, MO 65584-6558 | 2020-11-04 |
| 1013518224 | Brian James Voss | Pharmacist | 512 Deer Pointe Ct, Fenton, MO 63026-3061 | 2020-11-04 |
| 1730780917 | Amy Benson | Pharmacist | 5100 N Towne Centre Dr, Ozark, MO 65721-7479 | 2020-11-04 |
| 1952902355 | Aaron Kate Menley | Pharmacist | 2025 West Business Highway 60, Dexter, MO 63841-6384 | 2020-11-03 |
| 1447851043 | Elizabeth Ahrens | Pharmacist | 625 Sw Us Highway 40, Blue Springs, MO 64014-3232 | 2020-11-02 |
| Find all providers with the same taxonomy | ||||
| City | CARUTHERSVILLE |
| Zip Code | 63830 |
Please comment or provide details below to improve the information on MR. SHANE A DUDLEY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.